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Where can I locate the criteria that a beneficiary needs to meet for an “automatic” exception to the therapy caps?

April 26, 2017automatic Beneficiary caps criteria exception locate meet Needs therapy

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Where can I locate the criteria that a beneficiary needs to meet for an “automatic” exception to the therapy caps?

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The criteria for an automatic exception to the therapy cap can be found at: • CMS Manuals; Claims Processing Manual, Publication 100-04, Chapter 5, Section 10.2.C. 2, Automatic Process Exceptions Not all patients who have a condition or complexity on the list are “automatically” excepted from therapy caps. See Pub. 100-02, chapter 15, section 230.3 for documenting the patient’s condition and complexities.