The Middle Class Job Creation and Tax Relief Creation Act (MCTRJCA) of 2012 established criteria to manage expenditures for Outpatient or Part B services for all outpatient/Part B therapy services, regardless of the setting.
This legislation outlines the following:
- Established the Manual Medical Review/Advanced Approval Process and a $3,700 cap
- Also directed congress to study OP outcomes/implement a data based outcomes tool
- Exceptions to the therapy caps remain in effect (KX modifier)
- Hospital OP and Critical Access Hospitals (CAHs) claims for therapy services are included in the $1900 and $3700 cap
- Editing remains in effect to suspend claims for therapy services that exceed the $3700 cap
- Directed Congress to form a task force to study the efficacy of Part B services
- The Claims Based Data Collection has been designed to provide collection of data on patient function during the course of therapy services to better understand patient condition and outcomes
- G codes are 42 new non-payable functional G-codes and 7 new modifiers that will be submitted on all claims for Outpatient/Part B PT, OT and SLP services
- G code and modifier is selected by the registered therapist and will be integrated in Casamba
- G codes and modifiers will be added at the time of the initial evaluation, every 10th visit (or before) and at the time of the Discharge to give a measurement of baseline, progress and status as the time of discharge
- Compliance with submission of the G codes and modifiers is required by the June 30th, 2013 deadline
All therapists should consider the following when selecting the G code and associated modifiers:
- Does the G code BEST represent the main focus area of therapy and the one that you would expect the most impact?
- Did you document on the G code status as well as the goal?