Medicare Part B Independent Physical, Occupational and Speech Therapy Providers

National Government Services is addressing providers who frequently submit clerical error reopenings to add the KX modifier to Medicare Part B claims for physical, occupational and speech therapy services. 

Here are some key points to help you avoid these extra clerical tasks:

1. Use NGSConnex: Utilize the NGSConnex portal to check eligibility thresholds in advance. This can help you accurately calculate when you are nearing the therapy caps.
2. Precalculate and Submit Correctly: Before submitting claims, precalculate up to the therapy cap and add modifier KX directly on the initial claim submission when the therapy services exceed the threshold.
3. Understand the KX Modifier: Only use the KX modifier when services at or above the therapy threshold, are medically necessary and appropriate documentation exists in the medical records. See LCD requirements: LCD L33631 Outpatient Physical and Occupational Therapy Services
4. Prepare for 2025: Be aware of the new annual therapy limit for 2025, which is $2,410 for PT and SLP services combined, and $2,410 for OT services alone.
5. Access Resources: Utilize available resources to ensure you are submitting claims accurately the first time
   • NGSConnex User Guide
   • Billing and Coding: Outpatient Physical and Occupational Therapy Services (A56566)

These steps can help streamline your process, reduce clerical errors and improve claim accuracy, ultimately saving time and reducing the frequency of reopenings.

If you have questions or want to learn more, join us for an upcoming webinar. You may register below or via our Events page. 

Posted 2/3/2025