I am often asked by therapists, office managers, biller’s, billing companies, etc., if the application of the KX modifier is allowed for Medicare beneficiaries who have exceeded $3700 physical and speech therapy combined in a calendar year or a separate $3700 for occupational therapy in a calendar year. Providers of therapy services are under the impression that Medicare beneficiaries have 2 therapy caps, one at $1940 in calendar year 2015 and a second therapy cap at $3700. Providers are also under the impression that once a Medicare beneficiary exceeds $3700, the KX modifier is no longer allowed to be applied to CPT codes on the claim form and that they must have the Medicare beneficiary or their representative sign an advance beneficiary notice of noncoverage even though the treating therapist has determined services are still medically necessary and require the unique skills of a therapist to provide.
Lets make one thing clear. There is only one annual therapy cap and in 2015, it is
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