AOTA has consistently reached out to the Center for Medicare and Medicaid Services (CMS) officials for guidance on how to handle claims approaching or exceeding the current cap, but has received no answer as of the publication of this article. Until we receive further guidance, AOTA recommends that therapy professionals issue a mandatory Medicare notice, called an Advanced Beneficiary Notice of Non-Coverage or “ABN,” to all Medicare beneficiaries they treat who reach the $2,010 cap.  The ABN is issued in situations where Medicare payment is expected to be denied.  Because Congress didn’t extend the exceptions process permitting the attachment of a KX modifier or the manual medical review process, it is your duty to notify your patients that their therapy services may be limited.


With this impending crisis, you must contact your members of Congress and ask them to take action to ensure all beneficiaries can receive the therapy services they need. Therapy can't wait.