CHA News Article

CMS Issues Additional Information on Therapy Cap Manual Medical Review

The Centers for Medicare & Medicaid Services (CMS) has issued information outlining the interim process for manual medical review for claims for therapy services that exceed the $3,700 threshold. The American Taxpayer Relief Act of 2012 extended the manual medical review process for claims exceeding $3,700 for physical therapy and speech/language pathology services, and/or $3,700 for occupational therapy services per beneficiary per year. CMS notes it is developing a long-term strategy to deal with manual medical reviews. In the interim, Medicare Administrative Contractors (MACs) will conduct pre-payment reviews for claims above the threshold. CMS has requested that MACs conduct the reviews within 10 days. At this time, there is no process in place for an advance request of an exception. For additional information, visit the CMS website at