Eli's Rehab Report

Published on Fri Apr 17, 2009 PDF

The outpatient therapy cap is $1,840 for 2009, but your CMS contractor's claims system won't reflect that until April. It will reject therapy claims that exceed the2008 cap amount of $1,810 until then, CMS said in Feb.13 CR 6321 (Transmittal No. 1678).

However, if your claims are valid and you have good documentation to back them up, you are still entitled to the full 2009 cap amount. The solution: If you get a rejected claim, just treat it as you would if you were submitting for a therapy cap exception. Just resubmit the claim with the KX modifier for payment, CMS instructed in the memo, online at www.cms.hhs.gov/transmittals/downloads/R1678CP.pdf. As always, the therapy caps do not apply to hospital-based settings.