Medicare Part B Therapy Cap Exceptions Process

On April 1, 2014, the president signed into law the Protecting Access to Medicare Act of 2014, which temporarily extended the therapy cap exceptions process and manual medical review for therapy services until March 31, 2015. The following provides speech-language pathologists with relevant information on the exceptions process, manual medical review process, and documentation requirements. Speech-language pathologists may use the automatic exceptions process for any diagnosis and complexity, so long as they have documented justification on why the services for the particular patient exceed the cap. The 2014 therapy cap is $1,920 for speech-language pathology and physical therapy services combined.

See also: ASHA's Reimbursement News

ASHA Resources

CMS Instructions

Questions? Contact

Our Partners