Medicare Part B Therapy Cap Exceptions Process
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 2016 therapy cap is $1,960 for speech-language pathology and physical therapy services combined.
- On February 9, 2016, the Centers for Medicare & Medicaid Services (CMS) released
information regarding a new manual medical review process for therapy services provided through December 31, 2017. However, very little detail regarding implementation was provided.
- On April 16, 2015, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015, which temporarily extends the therapy cap exceptions process and modifies the manual medical review process for therapy services through December 31, 2017.
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