2007 Process

• 2007 Outpatient Therapy Cap Automatic Exception Process (Page Posted: 01/26/2007)
• MLN Medlearn Matters Article MM5478 (Page Posted: 01/17/2007)

2006 Process

• 2006 Exception Process Slide Show or PDF Document (Page Last Modified: 3/29/2006)
• Overview (Page Last Modified: 01/03/2007)
• Instructions (Page Last Modified: 3/29/2006)
• To view frequently asked questions and answers regarding Therapy Caps, please refer to our FAQ database at http://www.empiremedicare.com/faq/faq.cfm
• Automatic Exception Diagnosis Listing (Page Last Modified: 01/03/2007)
• Documentation Guidelines and Examples (Page Posted: 4/14/2006)
• Part B New Jersey Exception Request Form (Page Last Modified: 3/29/2006)
• Part B New York Exception Request Form (Page Last Modified: 3/29/2006)
• Sample Response Letter – Approval
• Sample Response Letter – Denial for Medical Necessity
• Sample Response Letter – Denial for Insufficient Documentation
• Sample Response Letter - Partial Approval

Providers are reminded that manual exception requests should not be submitted with any diagnosis that qualifies for automatic exception. These claims should be submitted with a KX modifier for automated processing.

Page Last Modified:   03/05/07