What does CPT modifier KX mean?

Modifier KX Use of the KX modifier indicates that the supplier has ensured coverage criteria for the billed is met and that documentation does exist to support the medical necessity of item.

What type of modifier is KX?

The KX modifier is a signal on a claim that though the patient services have met the capped amount allowed, the provider deems continued care medically necessary. As the description in the below table indicates, medical record documentation must be maintained to support the medical necessity of the continued services.

Where does the KX modifier go?

The KX modifier is appended on claims at or very close to the $1920 cap, and should not applied from the first visit, even if the therapist knows that the cap will likely be exceeded. At least one MAC has notified therapists that a pattern of early application of the KX modifier may be consider an abuse practice.

What is the KX modifier threshold?

The KX modifier threshold process applies an annual Medical Record (MR) threshold amount when a beneficiary’s incurred expenses reach a threshold of $3,000. This amount will remain until calendar year 2028.

Does modifier KX affect payment?

When the KX modifier is appended to a therapy HCPCS code, the contractor will override the CWF system reject for services that exceed the caps and pay the claim if it is otherwise payable.

How long can you use KX modifier?

Nope, there is no upper limit—as long as the services you are providing are medically necessary. However, there are additional steps you must take if you believe treatment beyond the manual medical review threshold of $3,700 is medically necessary.

Is KX a valid modifier?

The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.

Does Aetna require KX modifier?

Effective June 1, 2020, we’ll allow hemodialysis services billed with modifier KX. You can use this modifier to report services required in excess of the three times per seven-day period. Be sure to include the KX modifier on your bill to us, if necessary.

Does Medicare cover Pelvic Floor therapy?

Insurance Coverage of Pelvic Floor Treatment For example, while Medicare does cover physical therapy for pelvic floor dysfunction, there is a $1,900 per year cap. In other words, some Medicare patients will end up paying out-of-pocket physical therapy costs when treatment exceeds $1900.

Does Aetna accept XS modifier?

1, 2020. Aetna’s policy is consistent with the CMS changes. The Aetna decision significantly reduces the instances in which a PT will need to append the 59, X, XE, XP, XS, or XU modifiers and will eliminate situations in which certain code pairs were prohibited.

How do you bill for pelvic floor therapy?

CPT90912 and CPT90913 can be reported for pelvic floor dysfunction and physical therapy. Physical therapy services are performed to restore the function of the pelvic floor.

How do you code pelvic floor therapy?

CPT Code 90901 is a non-specific code that can be used for any modality of biofeedback therapy. In contrast, CPT Code 90911 is used to bill for Pelvic Floor Therapy training for the treatment of incontinence.