If you are a physician that provides PT/OT/ST services to MVP Medicare Patients, then this blog post is for you!

KX modifier should NOT be used when the member did not exhaust that member’s PT/OT/ST benefits.

Claims that require a therapy cap exception and are billed with the KX modifier must:
• Qualify for the therapy cap exception
• Be medically reasonable and necessary services that require the skills of a therapist
• Be justified by appropriate documentation in the medical records and would be available for review upon request

Providers: Please log on to the MVP website and verify member benefits to see that member met their annual PT/OT/ST visit cap.

If you find this type of information useful? Follow my blog for more medical billing and coding guidelines, medical policy/reimbursement policy changes and anything else healthcare related.

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