Life is about change, right?  Well we certainly have been seeing change again with part B therapy.

Therapy Cap and Manual Medical Review:  The exceptions process was extended through December 31st of this year which also extends the manual medical review process.

However, there was some confusing language by CMS which states, “The law requires an exception process to the therapy cap that allows providers to receive payment from Medicare for services above the therapy cap amount.  No automatic exceptions will be granted in 2013.  CMS is in the process of determining how the manual medical review process will be conducted in 2013.  CMS will post further details regarding this process as soon as possible“.  This Therapy Cap information can be located here:

Once CMS provides clarification on the manual medical review process, we will be sure to communicate that information to you.

Functional Limitation Reporting went into effect January 1st of this year with a testing period through June 30th.  Starting July 1st, claims submitted without the G-Codes and Severity Modifiers will be rejected and returned to providers and will be provider liability.  We have been training therapists, Clinical Managers, and Program Managers and will continue to train through February 22nd.

Our therapists are already starting to report the G-Codes and Severity Modifiers into our software system and in documentation!

We are extremely impressed with our therapist’s and manager’s commitment to this process! Thank you Functional Pathways’ therapists and managers!! 

We are looking forward to working with our partners in March preparing for reporting of the G-Codes and Severity Modifiers.  We will be sending out webinar information for those partners who are interested in participating.


Gina Henthorne LPTA, RAC-CT

Director of Compliance

Functional Pathways

Office:  234.208.8171

Cell:     330.696.9335

SecureFax: 1-855-685-1310



















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