tci Outpatient Facility Coding Alert - 2012 Issue 1

Reimbursement: Keep a Check on Therapy Caps, or Risk Repeated Reviews

Get advanced approval if patient nears $3,700, or wait up to 60 days for CMS payment. If your ASC provides therapy services, get ready for closer scrutiny. All therapy payments are subject to CMS manual medical review after the patient reaches $3,700 in exceptions, effective Oct. 1, 2012. Know When KX Still Applies -- and When It Doesn't The first level to therapy cap exceptions remains the same, even after Oct. 1. When the patient reaches the $1,880 therapy cap, bill your services with modifier KX (Requirements specified in the medical policy have been met). Verify...

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