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Medicare Blog and Updates

  • 30 Nov 2018 10:57 AM | Zachary Edgar (Administrator)

    Effective Date: January 1, 2019

    Applicable Providers

    Physicians, therapists, and other providers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs, for outpatient therapy services provided to Medicare beneficiaries.

    Compliance Change

    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 annual per-beneficiary incurred expense amounts now known as the KX modifier thresholds, and related 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amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law.

    Reference

    MLN Matters Number: MM11055


  • 9 Nov 2017 10:56 AM | Zachary Edgar (Administrator)

    Effective Date: January 1, 2018

    Applicable Providers

    Therapists, physicians, and other providers submitting claims to Medicare Administrative Contractors (MACs), including Home Health & Hospice MACs, for outpatient therapy services provided to Medicare beneficiaries.

    Compliance Change

    For physical therapy and speech-language pathology combined, the CY 2018 cap is $2,010. For occupational therapy, the CY 2018 cap is $2,010. Make sure that your billing staffs are aware of these therapy cap value updates.

    Reference

    MLN Matters Number: MM10341

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