Physical Therapy/Occupational Therapy/Speech Therapy

KX Modifier Threshold

The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record.

  • For CY 2024, the limit on incurred expenses is $2,330 for PT and SLP services combined. There’s another limit of $2,330 for OT services.
  • For CY 2023, the limit on incurred expenses is $2,230 for PT and SLP services combined. There’s another limit of $2,230 for OT services.

Deductible and coinsurance amounts paid by the beneficiary for therapy services count toward the amount applied to the limit.

Providers can find out if your patient is approaching their therapy cap by checking the patient’s eligibility record in NGSConnex. If you have not signed up for NGSConnex please visit the aforementioned link.

The therapy cap applies to all Part B outpatient therapy settings and providers including:

  • Therapists’ private practices
  • Offices of physicians and certain NPPs
  • Part B SNFs
  • HHAs (TOB 34X)
  • Rehabilitation agencies (also known as ORFs)
  • CORFs
  • HOPDs
  • CAHs (TOB 85X) ‒ (2014)

Related Content

Revised 1/25/2024