Reimbursement: Keep a Check on Therapy Caps, or Risk Repeated Reviews

Why This Topic Matters

The article matters because it addresses when therapy claims may face additional review or delayed payment under CMS oversight. Readers who bill or manage outpatient therapy services need to understand the policy timeline and administrative steps that can affect reimbursement continuity.

Article Sections

1. Know When KX Still Applies — and When It Doesn't

   Explains the therapy cap exception process and how CMS review changes once higher payment thresholds are reached. It also discusses advance approval and related billing workflow considerations.

2. Learn When the New System Applies to Your ASC

   Describes the staged implementation of manual medical review across provider groups and the factors mentioned in the rollout process. It also covers how the policy applies before a provider’s phase-in date.