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CMS urges caution on use of therapy cap modifier
Rehab Private Practice Alert, March 8, 2006
Therapists should use caution in using the KX modifier to apply for an exception to the therapy cap, according to guidance from CMS.
The agency says the modifier should be used only when documentation in the medical record supports that services beyond the cap are medically necessary, reported PT Bulletin Online.
The American Physical Therapy Association is continuing to work with CMS to provide additional clarification on exception process questions, such as some local contractors not reimbursing for services billed using some of the ICD-9 codes on the automatic exception list.
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