Therapy cap Indicator 1 Code

This variable is contained in the following files:

Carrier (Fee-for-Service) Home Health Agency (Fee-for-Service) Hospice (Fee-for-Service) Inpatient (Fee-for-Service) Outpatient (Fee-for-Service) Skilled Nursing Facility (Fee-for-Service)

SAS Name

THRPY_CAP_IND_CD1

The field used to identify whether the claim line (or revenue center) is subject to a therapy cap.

Comments

This field appears on the revenue center/ line files.

In the Carrier line file, there are up to five indicators for the therapy cap - see variables called THRPY_CAP_IND_CD1 - THRPY_CAP_IND_CD5. In institutional revenue center files (inpatient, SNF, hospice, home health, and outpatient), there are two occurrences of this field (THRPY_CAP_IND_CD1 - THRPY_CAP_IND_CD2).

Details regarding the therapy cap can be found on the CMS website, under the Medicare therapy services web page (see, for example: https://www.cms.gov/Medicare/Billing/TherapyServices/index.html).

Source: NCH

Code	Code value
A	Hospital outpatient claims are subject to the therapy cap for this date of service (this indicator is used on institutional claims only).
B	Critical Access Hospital outpatient claims are subject to the therapy cap for this date of service (this indicator will be used on institutional claims only). Note: Currently, Critical Access Hospital claims are not subject to any therapy cap policies. Indicator B is created here to prepare for possible future legislation to include these claims.
C	The therapy cap exceptions process, as indicated by the submission of the KX modifier, no longer applies for this date of service (this indicator will be used on both institutional and professional claims).
D	The $3,700 threshold for review therapy services no longer applies for this date of service (this indicator will be used on both institutional and professional claims).