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Thread: Gone away is the -KX modifier...what's a practice to do?

  1. #1

    Default Gone away is the -KX modifier...what's a practice to do?

    AAPC: Back to School
    With Medicare eliminating the -KX modifier on July 1st, there's been some hot debate in our office for how to code for Medicare patients. I am inclined to bill with a -GP, -GA combo and have the patient complete an ABN, and submit claims in that format until we get a denial from Medicare and then deal with that however it comes down the pike. An office administrator spoke to someone at the APTA who suggested using a -GY modifier. That doesn't sit right with me since Medicare doesn't routinely or statutorily exclude physical therapy benefits. We have been unable to get a concrete answer on this. Does anyone have any information or suggestions for where we can get a more definitive ruling?

  2. #2


    Medicare has extended the effective date of the exceptions process to the therapy caps to December 31, 2009. Outpatient therapy service providers may now submit claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008.
    Before outpatient therapy service providers were instructed not to attach the KX modifier on claims for services furnished on or after July 1, 2008. The extension of the therapy cap exceptions is retroactive to July 1, 2008.
    Desiree Balladin CPC, CCS-P, PCA
    Billing Manager

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