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CMS clarifies therapy cap exceptions process for CAHs

February 8, 2013

Critical access hospitals will not have to request an exception or use a modifier in order for Medicare to cover outpatient therapy services when a patient has exceeded the annual payment cap on outpatient therapy services, the Centers for Medicare & Medicaid Services has informed the AHA, adding that it could revisit the issue again in the future. While the cost of these services will count toward the beneficiary's annual therapy cap, CMS said it will cover them when provided in a CAH without the need for an exception or modifier on the claim. AHA's critical access members today received a Special Bulletin with more information. The American Taxpayer Relief Act of 2012 extended the therapy cap to CAH outpatient therapy services for calendar year 2013 only.