Long-Term Care

Master the -KX modifier and therapy documentation

Billing Alert for Long-Term Care, November 1, 2009

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The therapy cap exception process is set to expire December 31. As of now, the only action on this issue is that legislation was introduced to repeal the caps on January
7 in the form of the Medicare Access to Rehabilitation Services Act.
If Congress does not act on this before January 1, 2010, the therapy caps will remain in place with no exception process. Until then, we must abide by the therapy cap process as outlined in Chapter 5, section 10.2 (c), of the Medicare Claims Processing Manual.
Under the exception process, when a therapist identifies that a beneficiary qualifies for medically necessary services in excess of the therapy caps, he or she can identify this by appending the -KX modifier to the claim for the charges in excess of the cap. However, this is not he only step that is needed.

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