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CRPS is Granted an Exception to Outpatient Medicare Physical
Therapy Cap
Section 4541 of the Balanced Budget Act of 1997 (BBA) required
the Centers for Medicare & Medicaid Services (CMS) to
impose financial limitations or caps on outpatient physical,
speech-language, and occupational therapy services by all
providers, other than hospital outpatient departments. The
law required a combined cap for physical therapy and speech-language
pathology, and a separate cap for occupational therapy.
Due to a series of moratoria enacted subsequently to the BBA,
the caps were only in effect in 1999 and for a few months
in 2003. With the expiration of the most recent moratorium,
the caps were reinstated on January 1, 2006 at $1,740 for
each cap.
RSD has been granted an automatic exception to the above
limitation.
CMS has established an exceptions process that is effective
retroactively to January 1, 2006. Providers, whose claims
have already been denied because of the caps, should contact
their carrier to request that the claim be reopened and reviewed
to determine if the beneficiary would have qualified for the
exception. In addition, providers who have not yet submitted
claims for services on or after January 1, 2006 that qualify
for the exception, should submit these claims for payment,
and refund to the beneficiary any private payments collected
because of the cap.
For complete details, see the CMS Fact
Sheet.
March 14, 2006
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