OPTUM NP'S

Below are the updated therapy caps for calendar year 2015.  The exceptions process will remain the same , through March 15, 2015)

 

Therapy Cap Values for Calendar Year (CY) 2015:

  • For physical therapy and speech-language pathology combined, the therapy cap will be $1,940.
  • For occupational therapy, the cap for 2015 will be $1,940.

 

Exceptions Process & Manual Medical Review (through March 31, 2015):

 

  • The exceptions process for the therapy caps (application of the KX modifier) has been extended several times through subsequent legislation. Section 103 of the Protecting Access to Medicare Act of 2014 extended the therapy caps exceptions process through March 31, 2015.
  • Exceptions to the therapy cap are allowed for reasonable and necessary therapy services. Per beneficiary, services above $3,700 for PT and SLP services combined and/or $3,700 for OT services are subject to manual medical review.