KX modifier amounts announced for CY19
The annual per-beneficiary incurred expense amounts are now known as the KX modifier thresholds. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. CMS recently posted a MLN Matters article with these amounts for CY2019, which were lowered by the BBA of 2018 which are as follows:
KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined = $2,040
KX modifier threshold amount for occupational therapy (OT) services = $2,040
The article also notes that the BBA of 2018 contains another provision that lowers the threshold of the targeted medical review process as explained in the Background section of the article. Make sure that your billing staffs are aware of these updates. Read the full article here.