KX Modifier Explained
The KX Modifier is to be used for therapy services that exceed the financial limitations and meet the automatic exceptions process for services rendered.
By adding the KX Modifier to a patients claim, the provider is attesting that the services billed:
- Are reasonable and necessary services that require the skills of a Physical Therapist (see CMS pub 100-2, Chapter 15, Section 220.2).
- Are justified by appropriate documentation in the medical record, (see CMS pub 100-2, Chapter 15, section 220.3).
- And qualify for an exception under the automatic exception process.
Adding Medicare Cap information to a Patient record in EMR
In Touch EMR allows you to add a patient’s Medicare Cap information, as well as append the KX Modifier to the patient’s claims going forward.
To add Medicare Cap information to a patient record in EMR, go to the Patient Dashboard:
- Edit Patient
- KX Modifier
- Medicare Cap
You will then want to enter the following:
- Current Medicare Cap Utilization
- Average Claim Amount per visit
- Estimated visits remaining (before medicare cap is reached)
Then hit UPDATE
The system will put an alert on the Patient Dashboard and count down as visits are documented for, and alert you when the Cap has been reached (based on the estimated data you entered).
If you think you may be close to the cap we suggest that you turn on the KX Modifier for all claims going forward.
The most accurate Medicare Information source for patient and claim data can be found by visiting the C-SNAP website
As mentioned before, we recommend turning on the KX Modifier when you are close to your Medicare Cap.
You can turn on the KX Modifier, by going to the Modifier Setting tab, and clicking Yes. This will then append the KX modifier on the patient’s claims going forward.
Make sure to hit Update when you are done.
Once you have added and updated the Medicare Cap information, an alert will appear on the Patient Dashboard letting you know how many visits remain before the Medicare Cap is reached.