Until Congress acts to extend the exceptions process or repeal the cap permanently or temporarily, the hard cap of $2,010 for combined speech-language pathology and physical therapy services is in place. The Centers for Medicare & Medicaid Services (CMS) has instructed providers to apply the KX modifier to all claims exceeding $2,010. CMS will hold claims with the KX modifier as long as they can, typically 14 days, before processing in order to allow Congress time to reach a solution.
Using an Advanced Beneficiary Notice (ABN) for possible noncoverage and patient liability for charges is optional. However, ASHA strongly recommends having patients who (a) receive services above the cap and (b) will have the KX modifier on their claims to review and sign an ABN until Congress officially takes action to address the cap. In addition, ASHA recommends collecting 20% of the fee-for-service at the time of service and be prepared to bill the patient the remaining balance if Congress does not act.
ASHA staff are contacting members of Congress, CMS staff, and fellow advocates on a daily basis seeking additional information that we will share with ASHA members as quickly as possible.
See ASHA's resource page on the 2018 Therapy Cap Implementation for details and additional background information. We are making all updates on the page as soon as possible.
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