Therapy cap exception extended for the remainder of 2010

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers a Medicare policy update extending the therapy cap exception process through the end of 2010. It is relevant to clinicians, therapists, and coders who bill outpatient therapy services under Medicare and need to understand the documentation and billing framework discussed in the Medicare Claims Processing Manual. The article also outlines diagnosis categories and therapy-related service codes referenced as part of the exception guidance.

Why This Topic Matters

Billing teams and therapy providers need to know when Medicare allows services beyond the annual therapy cap and what documentation and claim elements are associated with that exception. The article helps readers identify the scope of the policy change and the broad categories of diagnoses and therapy services tied to the guidance.

Article Sections

  1. Policy extension and billing context

    Introduces the 2010 extension of the therapy cap exception process and places it in the context of Medicare outpatient therapy billing. Summarizes the general policy update and the time period addressed.

  2. Documentation and claim reporting requirements

    Discusses the general documentation framework described in the source and notes the claim reporting element referenced for the exception process. Covers the broad administrative considerations without detailing selection rules.

  3. Therapy services referenced in CMS guidance

    Lists therapy-related service codes mentioned as part of the Medicare Claims Processing Manual discussion. This section indicates the types of evaluation services referenced in the article.

  4. Diagnoses that may qualify for the automatic therapy cap exception

    Presents the diagnosis categories and code groupings cited by the source as associated with the automatic exception discussion. The section is organized as a reference list tied to the Medicare guidance.

What You Will Learn

  • How the article frames the 2010 Medicare therapy cap exception extension
  • What general documentation themes are associated with the exception process
  • Which therapy service code groupings are referenced in CMS guidance
  • What diagnosis categories are listed as potentially relevant to the exception
  • Which Medicare source document the article cites for further reading

Who Should Read This

  • Medical coders
  • Outpatient therapy billing staff
  • Physical therapy providers
  • Speech-language pathology providers
  • Compliance staff
  • Revenue cycle teams

Codes Discussed

Code Ranges Discussed

  • ICD-9-CM: V43.61-V43.69
  • ICD-9-CM: V49.61-V49.67
  • ICD-9-CM: V49.71-V49.77
  • ICD-9-CM: V54.10-V54.29
  • ICD-9-CM: 330.0-337.9
  • ICD-9-CM: 340-345.91
  • ICD-9-CM: 348.0-349.9
  • ICD-9-CM: 353.0-359.9
  • ICD-9-CM: 430-438.9
  • ICD-9-CM: 806.00-806.9
  • ICD-9-CM: 810.11-810.13
  • ICD-9-CM: 811.00-811.19
  • ICD-9-CM: 812.00-812.59
  • ICD-9-CM: 813.00-813.93
  • ICD-9-CM: 820.00-820.9
  • ICD-9-CM: 821.00-821.39
  • ICD-9-CM: 828.0-828.1
  • ICD-9-CM: 830.0-839.9
  • ICD-9-CM: 851.00-854.19
  • ICD-9-CM: 885.0-887.7
  • ICD-9-CM: 895.0-897.7
  • ICD-9-CM: 952.00-952.9
  • ICD-9-CM: 953.0-953.8

Modifiers Discussed


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