Therapy Cap & CPT Code Changes (January 1, 2018)

Is Your Clinic Prepared for 2018?

Therapy Cap & CPT Code Changes (January 1, 2018)


On January 1, 2018, a number of changes will go into effect that directly relate to the therapy industry. TheraOffice wants to make certain your practice is informed on all of the aspects that could potentially affect your day-to-day operations moving forward.

2018 Therapy Cap

As of December 19, Congress has officially recessed their session without properly addressing the Medicare therapy cap. There were hopes that the therapy cap would be fully repealed by the end of 2017, but at this point in time, that will not be the case. While it is possible that Congress could still address this issue in late January, the following changes will be going into effect on January 1, 2018 regardless:

  • The therapy cap (financial cap) for Medicare will be extended from $1,980.00 to $2,010.00. However, it will now act as a hard cap. As a result, the process of adding a KX modifier to a charge after a patient’s cap has been exceeded in order to still receive payment NO LONGER EXISTS. You are no longer able to KX charges anymore. If a patient reached their $2,010.00 cap and the provider feels that they should continue treatment, the provider would be required to have the patient sign an ABN (Advanced Beneficiary Notice). This is a form where the patient agrees to make payment on any services that Medicare deems medically unnecessary (which, in this case, is any service after $2,010.00).
  • In terms of the 2018 financial cap reset within TheraOffice, an update will be automatically applied to all web customers that will switch any patient’s cap that was previously set at $1,980.00 to $2,010.00. For on-site customers, an add-in will be available for download in the Administrator module under the Add-In Manager. Simply open the Administrator module, click on the Add-In Manager tab on the left-hand side, then click “Download Add-Ins” at the top of the screen. From there, select that very last option, “Other Add-Ins,” and you will be able to install the 2018 Financial Cap Reset within that section of the software. Doing so will trigger the same financial cap adjustments to take place.
  • Additionally, we are also encouraging individuals to take action by contacting their local legislators and members of Congress to share with them their support for the full repeal of the therapy cap.

2018 CPT Code Adjustments

On January 1, 2018, there will be a few changes to various CPT codes that your practice may be utilizing. The following list details all of the codes that will be affected:


  • 29582 – Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed.
  • 29583 – Application of multi-layer compression system; upper arm and forearm.
  • 97532 – Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training) direct (one-on-one) patient contact by the provider, each 15 minutes.
  • 97762 – Checkout for orthotic/prosthetic use, established patient, each 15 minutes.


  • 97127 – Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact.
  • 97763 – Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes.


  • 97760 – Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies), and/or trunk, initial orthotic(s) encounter, each 15 minutes.
  • 97761 – Prosthetic training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes.

While the above codes are not typical, primarily focusing on speech and orthotics, TheraOffice is prepared to accommodate your clinic if you use them.

  • For web customers, an update will be automatically applied to your database on 1/1/2018. This update will ONLY add in the new codes if the CPT codes they are replacing previously existed in your database (it will add 97127 if 97532 existed; it will add 97763 if 97762 existed).
  • For on-site customers, this will have to be a manual process. If you utilize any of the codes that are being altered, you will simply need to remove the deleted codes from your system on January 1, 2018 by going to to the Manage > Data > CPT Codes section in Documentation or Accounting. Once the outdated codes are removed, you will need to manually add the new codes that are replacing them. Additionally, you will be required to go to the Manage > Data > Treatments section in Documentation and re-link the associated treatments up with the new CPT codes that correlate with them in order for the suggesting charges function to operate properly.