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Medicare Cap Exceptions

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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

Phone #

Fax #

@...

www.bodywiseomaha.com

www.facebook.com/BodyWiseTherapyOmaha

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