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This variable is contained in the following files:
SAS Name
THRPY_CAP_IND_CD4
The field used to identify whether the claim line is subject to a therapy cap.
| 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). |
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.
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