Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2021 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Published Date:02/08/2018
Printed Date: 9/22/2015
URL: http://palmgba.com/marlowe/redesign6/article.html
Resolution/Resources On January 1, 2006, Medicare implemented financial limitations on covered therapy services (therapy caps). An exception to the therapy cap may be made when a beneficiary requires continued skilled therapy, (in other words, therapy beyond the amount payable under the therapy cap) to achieve his or her prior functional status or maximum expected functional status within a reasonable amount of time. Documentation supporting the medical necessity of those therapy services must be available in the patient's medical record.
Verify whether the patient has exceeded the therapy cap prior to submitting claims to Medicare through the Palmetto GBA eServices tool or Interactive Voice Response (IVR) unit. Online Verification for Therapy Caps through eServices
If the service qualifies as an exception and may be reimbursed over and above the cap, submit HCPCS modifier KX with the service. Documentation in the patient's medical record must support the use of this modifier.
HCPCS modifier KX must be submitted in addition to HCPCS modifier GN, GO or GP with therapy services when therapy cap meets all guidelines for an automatic exception. HCPCS modifier KX allows the approved therapy services to be paid, even though they are above the therapy cap financial limits.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 02/08/2018
We've recently uppgraded our website and it looks you're trying to access an old link. Please select an option below.
Attempt to load this page on new site
Go to Home page
Go to Contact Us page
View a related article: