Reason Code: CO-119

Error Description:

Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR group code.

Avoiding/Correcting This Error

The beneficiary has reached their therapy cap limit for the year.

The Bipartisan Budget Act of 2018 repealed application of the Medicare outpatient therapy caps but retains the former cap amounts as a threshold above which claims must include the KX modifier as a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.