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Possible Repeal of Therapy Caps

Updated: Sep 13, 2019

We have received and wanted to post some potentially good news for therapy providers. There may be a repeal of the therapy caps coming soon. Our current therapy cap extension will end December 31, 2017 and Congress is working diligently to restructure therapy extensions and the related medical review process.

The Cap Coalition met last Friday and its members are in general support of the proposed framework of the proposal developed by the three Congressional committees which includes:

1. The elimination of the $1,980 cap on physical therapy and speech-language pathology services as well as the $1,980 cap on occupational therapy effective January 1, 2018.

2. The continuation of the current process for targeted post-payment medical review with the current $3,700 threshold lowered to $3,000.

3. The inclusion of the "KX" modifier on claims over $3,000 with no modifier required for less than that amount (currently required for all claims over $1980.)

It is the view of the Cap Coalition that this proposed policy will provide appropriate oversite of therapy services, alleviate administrative burden, while eliminating the unnecessary and burdensome therapy caps. This general endorsement of the proposal is being conveyed to committee staff. Clarifications is also being sought from staff on various issues—e.g. confirmation that the targeting process for review is identical to the MACRA approach.

We believe that this is a major step forward but it is important to remember that this is only a proposal and the final product may be revised.

We will be posting on further developments as we are made aware.

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