Therapy caps are back, with a medical necessity exception for 2006; 90911 is off the list

Why This Topic Matters

The update affects whether certain therapy-related claims fall under Medicare’s annual limits and whether therapy modifiers are required when services are billed as part of a therapy plan of care. It is relevant for avoiding claim denials and understanding how CMS planned to handle claims impacted by the cap reinstatement.

Article Sections

1. Therapy caps and the 2006 exception review

   Overview of the reinstated Medicare therapy cap policy and the temporary exception process under consideration for 2006. Discusses CMS communications and the general policy context for the change.

2. Codes affected in outpatient therapy billing

   Summarizes the therapy-related service categories discussed in the article, including those referenced for urology and outpatient rehabilitation settings. Also notes the change in the list of services referenced for the year.

3. Claims Processing Manual language on therapy services

   Describes the manual guidance quoted in the article about when services are treated as therapy and when contractor review may apply. Focuses on the policy language rather than specific coding outcomes.

4. Cap amounts, beneficiary cost sharing, and modifier use

   Covers the stated annual cap amounts, beneficiary responsibility, and the need to apply therapy modifiers in the context discussed by the article. Includes the general billing implications tied to therapy plan-of-care services.