Medicare therapy threshold (KX)

Medicare sets a yearly amount for outpatient therapy: one for physical therapy and speech-language pathology combined, and one for occupational therapy. Once a patient's allowed amounts pass it, claim lines need the KX modifier, which says the services are medically necessary.

Turn it on#

In the payer's billing rules (Setup, Payers), turn on Track the KX threshold. The Medicare template has it on. Your clinic's modifier rules include a KX rule for Medicare that applies once the threshold is reached. Medicare requires KX past the threshold, so tracking applies to every discipline that counts toward it; each discipline's module settings set when the alert shows.

How the total is counted#

For each patient and calendar year NeatPractice adds up:

• the expected allowed amounts of the clinic's Medicare charges for the discipline group;
• finalized visit lines that are not charged yet, priced from the payer's fee schedule;
• prior amounts you type in from the patient's history with other providers.

The line that passes the threshold and every line after it get KX.

Attest medical necessity#

KX is only valid when the therapist attests that the services are medically necessary. On a signed plan of care, the therapist clicks Attest Medical Necessity. Until then, charges with KX are held with KX attestation missing; the hold lifts as soon as the attestation is recorded.

See the total and add prior amounts#

Open a Medicare charge in Charge review and choose Therapy Threshold from the header menu. The dialog names the patient and chart, then shows each total against the year's threshold and the prior amounts on file. A total past the discipline's alert share (80% to start) shows Past 80% until it crosses the threshold. Choose Add Amount to record an amount another provider billed this year, in dollars and cents, with where it came from. Remove one entered in error from its row actions.