Harmony Healthcare Blog

Therapy Caps (Medicare Part B) KX Modifier Thresholds: Top 4 Things to Know

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Jun 18, 2019


Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency • Survey

Through your feedback and requests (thank you by the way) today’s blog is a clarification of the Therapy Caps. 

In 2018, the Bipartisan Budget Act of 2018 (HR 1892), canceled the existence of Medicare Part B Therapy Caps. The historically named Medicare Part B Therapy Caps (now known as the KX Modifier Thresholds) went into effect January 1, 2019. 

The Act maintained the requirement that a modifier be included on claims over the exception threshold.  The modifier represents confirmation that the services are medically necessary.

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Topics: Medicare Part B, Therapy Caps

Therapy Screening

Posted by The Harmony Team on Wed, May 26, 2010

Therapy Screening: It is extremely valuable to ensure that all admissions (including-admission) at minimum receive a therapy screen.  This includes patients with a plan for long-term care placement may benefit from such therapy intervention.  The need for long-term care placement most likely is the result of functional decline.  Therapy intervention assists in establishing a true baseline from which improvement or decline may be measured.

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Topics: Medicare Entitlement, CMS, Medicare Reimbursement, Therapy Caps, Medicare Eligibility

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