Repeal of the Therapy Cap: A letter to our clients from Tracy Fritts

Good afternoon-

We are pleased to announce that the Bipartisan Tax Bill of 2018 that was signed into law early this morning included language that repealed the annual cap on Part B therapy services for Medicare beneficiaries retroactive to January 1, 2018.  As an industry we have been working on legislation to repeal this very bad policy for over 20 years.

Medicare still requires a KX modifier on claims for services over $2010 (PT/ST combined and a separate $2010 for OT) to signal the ongoing medical necessity.  Claims that exceed $3000 may be selected for a targeted Medical Review.  Targeted Medical Reviews are aimed at providers with unusual billing practices, those newly enrolled with Medicare, and those billing for services for specific conditions, etc.

We were surprised to see an offset that decreases the Medicare B Fee Schedule by 15% whenever the service is provided by an assistant instead of a therapist.  This will not occur until January 1, 2022, so we have some time to analyze and react to this.  If you would like to check out the details here is the link to the Full Text.

You are all aware of residents who needed therapy over the therapy cap amount in order to return to their maximum level of function.  Their stories, our communication to lawmakers, and the collaboration of all our trade/professional associations have resulted in this successful repeal.  Thank you for your ongoing partnership!

Tracy Fritts, PT, MSPT, CEEAA
Vice President Quality and Outcomes