Wiki physical therapy modifier when annual therapy limit reached

[nadinecrowley@yahoo.com]

Hey All,
Just wondering if KX would be the modifier to use when Physical therapy annual limit has been reached for Medicare. ALso,do I send notes with claims? If KX is not the modifier to use what is? Thanks!

 

[nygiants42@hotmail.com]

The KX modifier is the correct one to use once they have reached their $1900 cap. This only applies to Medicare and not medicare supplemental insurances. The KX needs to be applied to every DOS for the month it is required even if they reach their limit on the last day of the month....you must go back and append all charges for that month to include the KX. They must have qualifying ICD-9 dx's to go over their limit. You can find a list of these here: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1414Cp.pdf

Also...the cap is separate for OT and PT...PT (including Speech Therapy) has its own $1900 and OT has a separate $1900. You do not need to mail anything to Medicare (unless they ask for it) until they are close to $3700, then you must submit the entire record to them for approval. They need that by the 15th of the month and have 10 business days to approve or deny. It is automatic approval if they do not get back to you within 10 business days, HOWEVER, that does not mean it is 'approved' for payment. They can still deny payment.

 

[nadinecrowley@yahoo.com]

thanks for your help!