RE: Medicare Cap Exceptions

[Guest guest]

Hi ,

CMS has said that any ICD-9 code that is allowed through your MACs LCD can be

used with the KX modifier. By using the modifier, the provider is attesting that

the services provided meet the medical necessity guidelines. So make sure you

have the LCD and go from there.

ine

ine M. o, PT

Owner

Encompass Consulting & Education, LLC

8114 NW 100th Terrace, Tamarac, FL 33321-1259

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From: PTManager [mailto:PTManager ] On Behalf Of

Sent: Wednesday, June 15, 2011 1:40 PM

To: PTManager

Subject: Medicare Cap Exceptions

Hello,

I am looking for a current list of the diagnosis that are allowed by Medicare

for reimbursement exception beyond the capped dollar amount. I found this

statement on page 10 of the Medicare Claims Processing Manual Chapter 5 - Part B

Outpatient Rehabilitation and CORF/OPT Services.

“The beneficiary may qualify for use of the cap exceptions at any time during

the episode when documented medically necessary services exceed caps. All

covered and medically necessary services qualify for exceptions to caps.â€

Is there a current list, and does anyone have a link to access it? Or are all

treatment diagnosis available to use with the KX modifier on for reimbursement

after capped dollars are exceeded?

Thank you for your assistance.

D. , PT

BodyWise Therapy, PC

2504 South 119th Street

Omaha, NE 68144-2947

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