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Region D

Issue Title

Postpayment Review – Manual Medical Review of Outpatient Therapy Claims above the $3,700 Threshold




In accordance with The American Taxpayer Relief Act of 2012 (ATRA) signed into law by President Obama on January 2, 2013, reviews will be conducted on outpatient therapy claims in SNF settings reaching the $3,700 threshold for PT and SLP services combined and/or $3,700 for OT services. When one or more lines of a claim have reached a therapy threshold, all lines of therapy services on that claim are subject to review.


All Region D states and WPS Legacy States, except FL, CA, MI, TX, NY, LA, IL, PA, OH, NC, and MO

Provider Type


Date of Service

Dates of service on and after January 1, 2013


The American Taxpayer Relief Act of 2012 (ATRA)​​

Date Posted


Date Revised


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Created at 6/5/2013 10:21 AM by Aaron Gough
Last modified at 6/5/2013 10:36 AM by Aaron Gough