Therapy Cap Manual Review Threshold to Ensure Appropriate

10.3.4 - Therapy Cap Manual Review Threshold to Ensure Appropriate Therapy (Rev. 4214, Issued: 01-25-19, Effective: 01-01-19, Implementation: 02-26-19) Section 50202 of the Bipartisan Budget Act of 2018 retains the targeted medical review (MR) process (first established through Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)), but at a lower threshold amount of $3,000. For CY 2018 (and each calendar year until 2028 at which time it is indexed annually by the MEI), the MR threshold is $3,000 for PT and SLP services and $3,000 for OT services. The targeted MR process means that not all claims exceeding the MR threshold amount are subject to review as they once were. For a general overview of the MR process, go to the Medical Review and Education website at: https://www.cms.gov/Research-Statistics- Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical- Review/index.html