Wednesday, December 5, 2018

CMS Posts Annual Update to Part B Therapy Modifier and Targeted Review Dollar Thresholds

Dan Ciolek

CMS recently posted a MLN Matters article describing the annual per-beneficiary incurred expense amounts now known as the KX modifier thresholds, and related Medicare Part B therapy policy updates for CY 2019. 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amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. Another provision of the BBA of 2018 lowered the threshold of the targeted medical review process as listed below.

For CY 2019:
  • The KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined is $2,040. For occupational therapy (OT) services, the CY 2019 threshold amount is $2,040. 
  • The Targeted Medical Review (MR) threshold amount is $3,000 for PT and SLP services combined and $3,000 for OT services.

Make sure that your billing staffs are aware of these updates

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