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Physical Therapy Cap for 2008. Exception from Therapy
Service Cap using Modifier KX is ONLY Applicable to
Outpatient Hospital Setting

Between January 2008 until June 2008, the cap for Physical
Therapy services combined with Speech Therapy is $1,810.00.
Then, the "not-so-good" (or should I say, not good at all!) NEWS...

Effective July 1, 2008 --- the therapy services cap is still at
$1,810.00 for 2008.

But the exceptions (appended with MODIFIER KX) or the exempt
for medically necessary services will ONLY be applicable to Therapy
Services rendered at the Outpatient Hospital Setting.

On and after July 1, 2008 --- all services rendered at the office
setting will not be reimbursable if the patient had met his/her cap.

Always make sure you check on your patients eligibility and inform
your patient prior to rendering the service.

Read more on MLN Matters -
Therapy Restrictions as of July 1,
2008 from the CMS Website.

**** For more references: Consult your CPT code books.  The National
Correct Coding Initiative (NCCI) and third pary payer payment policies
and guidelines