Bipartisan deal would make therapy cap exceptions permanent

by: Laura Evans, CPC Dec 11, 2017

The therapy cap exception process – due to expire at the end of this year – may be extended permanently, though physicians may be paying for it with reductions to their Medicare fees.

The exception extension is part of a bipartisan agreement by members of the House Ways and Means Committee recently. Members of the committee are still working out all the details but are hoping to pass the legislation before this year’s Congressional session ends on Dec. 22.

The therapy cap exception process allows therapy practices to exceed Medicare’s annual spending cap when medically necessary. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 extended the cap exceptions to the end of this year. Without them, when a Medicare beneficiary’s therapy exceeds the annual cap, the patient must pay for the additional charges.

The annual 2018 therapy cap is $2,010 for both physical therapy and speech-language pathology. A separate annual cap of $2,010 applies to occupational therapy.

As well as extending the cap exceptions indefinitely, the bipartisan legislation would also include a two-year extension of the Medicare geographic payment cost index for physicians, among other MACRA provisions, according to a Nov. 15 Ways and Means press release.

The bill would pay for therapy cap exceptions and the other extensions in part by continuing to target misvalued codes for physician services, the release states. According to that policy, CMS must reduce physician fee schedule spending by a certain amount by reducing the relative value units (RVUs) for misvalued codes. If the agency can’t meet the target reduction by revaluing misvalued codes, it must subtract the additional amount from the physician conversion factor.

Watch this space for updates on the legislation.

Blog Tags: CMS, fee schedule

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