The American Occupational Therapy Association touted extension of the therapy cap exceptions process through the remainder of 2012 under the Middle Class Tax Relief and Job Creation Act of 2012, passed by Congress and signed into law by President Obama in February. The legislation also creates changes in the process, including:
The KX modifier, intended to note spending beyond the level of the cap and attest to the medical necessity of those services, must now be used on all claims exceeding the statutory level of the cap of $1,880 for 2012.
Effective Oct. 1, all therapy claims must include the national provider identifier of the physician responsible for certifying and periodically reviewing the plan of care.
Also effective Oct. 1, all claims exceeding $3,700 will be subject to a "manual medical review process." The law notes that this process should be similar to the manual review under the original exception process instituted in 2006.
No later than Oct. 1, the therapy cap of $1,880 with exceptions will be applied to hospital outpatient department settings. This cap will expire on Dec. 31. HOPD settings were exempted from the cap to allow a safety net for beneficiaries if and when other outpatient settings were subject to the cap. Extending the temporary cap to HOPD with exceptions creates a uniform system of utilization control across all outpatient settings and does not restrict access to medically necessary care.
(Source: todayinot.com)
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