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 2017 therapy cap is $1,980 for speech-language pathology and physical therapy services combined.

New Developments

  • 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.

Please continue to monitor this site or sign up for ASHA Headlines for updates on changes to the manual medical review process.

See also: ASHA's Reimbursement News

ASHA Resources

CMS Instructions

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