The Physical Therapy cap for Medicare increased in 2018 to $2010.00

However, Congress broke for break this year without addressing the therapy cap exceptions.

On Friday 1/26/18, CMS/Medicare released a “rolling hold” to minimize impact if legislation to extend the outpatient therapy caps exceptions process is enacted.

The government has a 2/8/18 deadline to determine how to proceed with the therapy cap exceptions this year. Updates will follow as the rules are released.

It is unknown how the KX modifier and exception to the therapy cap will play out in 2018 yet.

As of right now,

• The therapy caps exceptions process ended Dec. 31, 2017.

• Medicare beneficiaries are limited to $2,010 of therapy under each therapy cap in 2018.

• Therapy over the cap is statutorily excluded as a Medicare benefit in the absence of an exceptions process.

• The therapy caps apply to all therapy service locations, with the exception of hospitals. The therapy caps do apply to critical access hospitals (CAHs).

• Beneficiaries are financially responsible for all therapy costs over the therapy cap (again, with the exception of services provided in hospitals).

• Providers should issue a mandatory advanced beneficiary notice of non-coverage (ABN) to advise beneficiaries of non-coverage of therapy over the cap.