Insurance

Medicare Therapy Cap

The annual dollar threshold for outpatient therapy services under Medicare, above which services require additional documentation and the KX modifier.

In Detail

Medicare sets annual thresholds for outpatient therapy: one combined cap for PT and SLP services, and a separate cap for OT. In 2024, the threshold is $2,330. Services below the threshold are processed normally. Above the threshold, the KX modifier must be applied and targeted medical review may occur above $3,000. PRACTIS tracks each Medicare patient's year-to-date therapy spend and alerts clinicians when approaching the threshold.

Related Search Terms

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