Medicare Exception Process

[Guest guest]

Hi All,

I recall reading several months ago that a medicare patient with a new

unrelated diagnosis is eligible for exception with the KX Modifier in

the same calander year. For Example, in Feb.'08 a patient is seen for a

shoulder problem and uses $1400. Then returns Oct. '08 with a Low Back

condition. Once the Limit is reached can you use the KX based on a

different Dx. I read the Medicare Claims Processing Manual (Chapter 5)

and don't see anything about this in there. I also understand Medical

Necessity needs to be taken into consideration.

Thanks for any input.

Saidi PT, MPT

Cape Coral, FL