Congress Repeals Medicare Therapy Caps and Lifts Limits on Speech-Generating Devices
Congress has permanently repealed Medicare Part B therapy caps and permanently extended the Steve Gleason Enduring Voices Act, which authorizes the purchase of speech-generating devices (SGDs).
The measures were included in a continuing resolution passed yesterday that funds the federal government for the next two years.
Medicare Part B Therapy Cap
The resolution permanently eliminates the hard cap on how much outpatient speech-language, occupational and physical therapy each Medicare beneficiary is allowed per year. Congress has allowed an exceptions process in most of the past 20 years, but this permanent fix repeals the cap and replaces it with a more flexible targeted medical review threshold of $3,000.
Even with a threshold of $3,000, clinicians must use the KX modifier—which indicates ongoing medical necessity—when a patient’s therapy services exceed $2,010 (the level of the previous cap). If an SLP meets certain billing criteria (yet to be announced), the clinician may be required to submit medical records for some of the claims above the $3,000 threshold for review.
ASHA anticipates that the targeting criteria and review process will be similar or identical to the most recent therapy caps exceptions process. We will share the details when they become available.
Steve Gleason Enduring Voices Act
The resolution also requires Medicare to cover the purchase of SGDs permanently. Most of the people who use SGDs have neurodegenerative diseases such as amyotrophic later...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - Category: Speech-Language Pathology Authors: Jeffrey Regan Tags: Advocacy Audiology Speech-Language Pathology Augmentative Alternative Communication Technology Source Type: blogs
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