Home Health & Hospice Week

The threshold formerly known as the outpatient therapy cap has increased for this year.

Reminder: The Bipartisan Budget Act of 2018 replaced the therapy cap with a threshold above which claims must include the KX modifier (see Eli’s HCW, Vol. XXVII, No. 10). The modifier indicates that services are medically necessary as justified by appropriate documentation in the medical record.

Important distinction: Therapy caps apply to outpatient therapy services furnished under Part B, including those provided in the home, but not to therapy furnished under the home health benefit.

For 2020, the outpatient KX modifier thresholds are $2,080 for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined, and $2,080 for Occupational Therapy (OT) services alone, the Centers for Medicare & Medicaid Services says in a MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11532.pdf. The 2019 thresholds were $2,040.