Please note that this article contains information that is only relevant for American clinics.
Earlier this year, Medicare facilities were shocked to learn that the US government was doing away with the therapy cap exception rule. However, in early February, senate passed a bill that reinstated the therapy cap exception rule. This means that therapists can continue to provide treatment to their Medicare patients without fear of those claims being denied even after their funding maximum has been exceeded. This is all done through the use of the KX modifier—and in the article, we’ll be showing you how easy it is to apply the KX modifier in Practice Perfect when completing your billing tasks.
One of the great things about Practice Perfect is its ability to help you track your patients’ remaining coverage. In the case of your PT, OT, and SLP Medicare patients, they all have a maximum coverage of $2,010. Once you enter this amount in the ‘Billing Rules’ section of their ‘Client Profile’, you’ll be warned when you try to enter new treatment and service charges or schedule new appointments when the patient is nearing their funding maximum.
So what do you do when a patient will be exceeding their funding maximum but they still require treatment? You use the KX modifier! The KX modifier indicates that even though the treatment is exceeding the funding maximum, it is medically necessary and vital to the patient’s recovery process.
To learn more about how to use the KX modifier, check out our tutorial video below about how enter treatment and service charges: