CMS to Phase-in Manual Medical Review Process for Part B Therapy Services

By statute, Part B outpatient therapy services are subject to an annual maximum payment ($1,880 in CY 2012 for occupational therapy (OT), and for physical therapy (PT) and speech-pathology services (SLP) combined). The statute also enacts an exceptions process to the therapy cap that allows providers to receive additional payments for Part B therapy services above the therapy cap amount.  The Middle Class Tax Relief and Job Creation Act of 2012 mandated manual medical review of therapy services.  Under the law, providers will be required to submit a request for an exception for therapy services above the threshold of $3,700 for OT and PT and SLP combined. Under the new process no automatic exceptions will be granted above the threshold based solely on a specific diagnosis.  A 3 –part phase-in approach will be used. For more information, please review the CMS Therapy Cap fact sheet and the Manual Medical Review Process FAQ.