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.
Recent Blog Posts:
- UHC Oxford- updated Prior Auth changes 01/01/2023
- UHC Exchange Plans: diabetes medications coverage.
- EmblemHealth Commercial Plan: Infusion POS Policy update
- BCBS of MN: Reimbursement update (modifiers 52, CO, CQ)
- BCBS of Minnesota: Medical and Pharmacy benefit updated 09/05/2022
#physicaltherapy, #occupationaltherapy #MVP #MVPmedicare #medicalbilling #medicalcoding
KR2 Medical Billing 