Medicare.gov: the official U.S. government site for Medicare

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Source: medicare.gov

FAQ: 2013 Medicare Therapy Cap

Does the therapy cap apply to critical access hospitals? For 2013, when a patient receives outpatient therapy services from a critical access hospital, the services will count toward dollars accrued toward the therapy cap. For example, if a patient receives $2,000 of outpatient therapy services in a CAH and upon discharge goes to a private practice to continue therapy services, the private practice would need to obtain an exception (in this case use the KX modifier). However, for 2013 the therapy cap does not apply to outpatient therapy services provided within CAHs themselves. This means that if the patient continued treatment in the critical access hospital, after exceeding $1,900 in therapy services, there would be no need to seek an exception through the automatic process. That is, the CAH would not need to submit the claim with a KX modifier. Also, if the patient exceeds $3,700 and continues care in CAH, the hospital would not need to obtain an exception through the manual medical review process.
Source: apta.org

Medicare Information and Plan Comparisons

While health care was not central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Source: medicare.org

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  5. FAQ: 2013 Medicare Therapy Cap

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