Wiki PT/OT KX Modifier

[aselvaggio5]

For physical therapy and Occupational Therapy, I know MCR requires the KX modifier once the patient has hit the $2040 cap to continue treatment. Does anyone know if this only applies to Novitas MCR or does it apply all MCR plans, for example UHC Medicare Advantage, AARP Complete or Aetna Medicare? I tried to look on the UHC site and also googled a lot of things, but the only thing I found was KX must be applied to all DME but no mention of any therapy usage. I am looking specifically for physical therapy/occupational therapy treatment and not DME. If you know where I should be searching as well, that would be helpful. I'm all googled out at the moment. I'm new to PT/OT coding and before me at my job they didn't have an actual coder, so I'm coming in very new and trying to learn all I can to bill correctly and educate. Thanks for any insight!

 

[thescientist8]

For physical therapy and Occupational Therapy, I know MCR requires the KX modifier once the patient has hit the $2040 cap to continue treatment. Does anyone know if this only applies to Novitas MCR or does it apply all MCR plans, for example UHC Medicare Advantage, AARP Complete or Aetna Medicare? I tried to look on the UHC site and also googled a lot of things, but the only thing I found was KX must be applied to all DME but no mention of any therapy usage. I am looking specifically for physical therapy/occupational therapy treatment and not DME. If you know where I should be searching as well, that would be helpful. I'm all googled out at the moment. I'm new to PT/OT coding and before me at my job they didn't have an actual coder, so I'm coming in very new and trying to learn all I can to bill correctly and educate. Thanks for any insight!

I've never added a KX modifier for Aetna Medicare nor UHC Medicare Advantage claims for PT/OT... You would think they will follow Medicare guidelines, since these are "Medicare" plans but not really.
Do you do both billing and coding? If so, send out the claims and wait till they get processed and start from there. You wouldn't know when the patient has already reached the max until you get a denial.
Feel free to message me if you have any PT/OT questions.

 

[BillingWithPurpose]

I've never added a KX modifier for Aetna Medicare nor UHC Medicare Advantage claims for PT/OT... You would think they will follow Medicare guidelines, since these are "Medicare" plans but not really.
Do you do both billing and coding? If so, send out the claims and wait till they get processed and start from there. You wouldn't know when the patient has already reached the max until you get a denial.
Feel free to message me if you have any PT/OT questions.

Hi, I know this is an old post but do you mind if I message you about this?