Beginning on January 1, 2007, the annual limit on the allowed amount for outpatient physical therapy and speech-language pathology combined is $1780; the limit for occupational therapy is $1780. However, you should note that also beginning January 1, 2007, for any services that are deemed medically necessary and the beneficiary meets the conditions described in the Medicare Claims Processing Manual (Pub. 100-04), Chapter 5 (Part B Outpatient Rehabilitation and CORF/OPT Services), Section 10.2 (The Financial Limitation) for 2007, may be processed using the automatic process. This exceptions process has been extended by recent legislation (the Tax Relief and Health Care Act of 2006) for one year (calendar year 2007). Remember that a therapy cap exception may be made when a beneficiary requires continued skilled therapy, (in other words, therapy beyond the amount payable under the therapy cap) to achieve their prior functional status or maximum expected functional status within a reasonable amount of time. Documentation supporting the medical necessity of those therapy services must be kept on file by the provider. The links below will take you to further instructions regarding the Automatic Exceptions Process. Page Posted: 01/26/07 |
