Do providers need to submit documentation for “automatic” exceptions from the therapy cap?
No specific documentation is submitted for automatic process exceptions. The clinician is responsible for consulting guidance in the Medicare Manuals and in the professional literature to determine if the beneficiary may qualify for the automatic process exception when documentation justifies medically necessary services above the caps. Medicare beneficiaries will be automatically excepted from the therapy cap and providers will not be required to submit documentation for an exception if the beneficiary meets the criteria for an automatic exception. Documentation justifying the services shall be submitted in response to any Additional Documentation Request (ADR) for claims that are selected for medical review. If medical records are requested for review, clinicians may include, at their discretion, a summary that specifically addresses the justification for therapy cap exception.
