10/23/08: Highmark Medicare Services – Time is running out!
To view those forms and all other pertinent information relative to Physical Therapy, please visit their
10/1/08: Medicare Changes – KX modifier re-instated!
7/1/08: Medicare Changes
There have been some changes to the Medicare Part B benefits that physical therapists need to be aware of. This information is relative to physical therapists NOT rendering services in a hospital setting. Remember that benefits for those types of services are processed under Medicare Part A.If you are not already aware, the cap for Physical Therapy & Speech-Language Pathology combined has increased from $1780 to $1810 per year effective 2008. That is the good news.
The bad news is that effective 7/1/08 Medicare is no longer recognizing the ‘KX’ modifier for services billed by these specialties under the Medicare Part B benefits. This modifier was used by providers when submitting claims to inform Medicare that the patient’s condition and treatment would exceed the cap allowance and should qualify for an exception. In this way the patient would hopefully be eligible for services to be reimbursed above the cap allowance.
Since the ‘KX’ modifier will no longer be accepted 7/1/08, we contacted Medicare to question what should be done when a patient’s care is such that it will exceed the cap allowance. They offered two options.
1)Have the patient sign an ABN notice that informs them their care may be denied due to exceeding the allowance cap. In this way you can use the ‘GA’ modifier on the claim submission and if the claim is denied stating the maximum has been met, the claim will deny with a “PR” denial which indicates ‘patient responsibility’. This will allow the provider to balance bill the secondary (if applicable) or to bill the patient directly.
2)Send the patient to a facility in which the patient can use their outpatient hospital benefits which is Medicare Part A.
The following is a link for providers to read further on this new change. This link in particular will take you to the website of National Government Services (one of the Medicare Carriers). From there you can use the hyperlinks to move to the actual CMS website to view their published information as well:
Here is also a link we found to a page of a website that notifies patients of the change.