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Applying the Therapy Caps to Critical Access Hospitals (CAHs)

This article is based on Change Request (CR) 8426 and alerts providers that:
• Beginning January 1, 2014, outpatient therapy services furnished by a CAH are subject to the
therapy cap and related policies;
• Pursuant to statute, the exceptions process, including the use of the KX modifier to attest the
medical necessity of therapy services above the caps, applies to services furnished by a
CAH in CY2014;
• Similarly, pursuant to statute, the manual medical review of claims in excess of the $3,700
threshold applies to services furnished by a CAH in CY2014; and MACs will no longer automatically apply the KX modifier to CAH services, effective January
1, 2014.

Download the Guidance Document


Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 17, 2014

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.