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Using the KX Modifier
2021 KX threshold amount: $2,110 for PT and SLP services combined.
2021 KX threshold amount: $2,110 for OT services.
The KX modifier applies to all Part B outpatient therapy settings and providers including:
By using the KX modifier on the claim, the therapy supplier or provider is attesting that the services are medically necessary, and that supportive justification is documented in the medical record.
The threshold is based on the incurred expanses made for the patient’s outpatient therapy services. It does not matter if therapy services are provided by one therapist or multiple therapists.
Claims for outpatient therapy services incurred above the threshold amounts without the KX modifier will be denied. Must be appended to all claims filed after the threshold amount has been reached.
Therapists can check the amount of expenses that have been made year to date (YTD) for the patient on the MAC websites: