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Clarification of Exemption Process to Therapy Limitation

PostPosted: Sat Nov 18, 2006 5:37 pm
by silkie
CMS has issued a clarification of the billing procedures connected with
the
exception process for annual limitations on physical and occupational
therapy.
The clarification may be found in:

MLN Matters Number: MM5271
Related Change Request (CR) #: 5271
Related CR Release Date: November 9, 2006
Effective Date: October 3, 2006
Related CR Transmittal #: R60BP, R171PI, R1106CP
Implementation Date: October 3, 2006

Outpatient Therapy Cap Exceptions Clarifications

Reference is made to the automatic exemption conditions, i.e. those
diagnostic codes, treatment of which is exempted from the yearly limit.

Listed in Medicare Claims Processing Manual, Pub. 100-04, Chapter 5,
(as
revised by CR4364):

457.0-457.1
POSTMASTECTOMY LYMPHEDEMA SYNDROME AND OTHER LYMPHEDEMA

Note that ICD-9-CM diagnostic code 757.0 for congenital lymphedema of
the
lower limbs is not listed as an automatic exemption, and would have to
be applied
for as a "manual exemption" or coded as 457.1 other (than
postmastectomy)
lymphedema.

Robert Weiss, M.S
Lymphedema Treatment Advocate


Thank you Robert xx