Page 81 - R2P Front Desk Manual v1

Medicare - KX Modifier Purpose/Procedures

KX Modifier Purpose per WebPT documentation:

The therapy cap isn't necessarily the end-all, be-all of reimbursement for a particular patient. If
you believe that continuing therapy with a patient is medically necessary—thus qualifying the
patient for an exception to the cap—all you have to do is attach the KX modifier and clearly
document your reasons for continuing treatment. This is known as the automatic exceptions
process. There’s no need to submit additional documentation or supplemental forms to use the
KX modifier, but by attaching the KX modifier to a claim, you attest that the services billed:

● Qualify for the cap extension
● Are reasonable and necessary
● Require the skills of a therapist
● Are justified by supporting documentation in medical notes/records

Clinic Coordinator/PT Process for proper documentation:

When a patient is close to reaching their Medicare “therapy cap,” an automatic window in the
patient’s chart will alert the front desk/PT that the KX modifier must be applied in order to
receive continued treatment. To apply the KX modifier:

1. The Clinic Coordinator or PT will open the patient’s case. Click Edit.
2. Scroll to the bottom to Apply Modifier. Click the circle to select KX (it will automatically
be on None prior to turning on the KX modifier), click Ok, and Save Patient.

3. Once the KX modifier is applied, the PT will clearly document (per bullet points above)
reasons for continued treatment through Daily Notes and use trigger words that help to
further justify the need for continued treatment (i.e. ADL limitations, risk limitations, etc.).
4. PTs must fax all initial eval and progress notes for ALL Medicare patients to physicians
with request for signature to be returned (check the box for Request Physician
Signature when faxing from WebPT).
a. Signed physician notes can be used to show medical necessity of treatment.
5. Clinic Coordinators must track physician signature requests and closely monitor that all
are returned and properly uploaded to patient charts in WebPT.

Last Update: 7/9/19