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CMS announces therapy cap exceptions process

Rehab Private Practice Alert, February 15, 2006

The Centers for Medicare & Medicaid Services (CMS) announced its plans for an exceptions process for the $1,740 therapy cap less than a week after President Bush signed the budget reconciliation bill (S. 1932) into law.

CMS issued three transmittals describing the new process, which will take effect March 13. To view Transmittal 46, click here. For Transmittal 139, click here and for Transmittal 853, click here.

The process allows for an automatic exception involving diagnosis, complexity, and other factors for specified patients, as well as a written request exception, which allows for a provider to request up to 15 days of further treatment based on medical necessity.

With the written request process, if Medicare does not issue a response within 10 days, the services are automatically deemed necessary.

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