Physical therapists from around the country recently received comparative billing reports (CBRs) evaluating use of the modifier KX. The reports compare a provider's KX usage with his or her peers, and are for informational purposes only, says Safeguard Services LLC, a nationwide contractor running the program.
Modifier KX allows providers to bill therapy services for patients who have exceeded Medicare's physical therapy cap of $1,860 or occupational therapy cap of $1,860. Safeguard reviewed 2009 claims from 5,000 providers to see if the modifier was being used properly. The contractor says: "Physical Therapy providers are instructed to use the KX Modifier to indicate that the services that they are rendering are: (1) medically necessary and that justification is documented in the medical records, (2) the physical therapy financial limitation cap has been met, and (3) that the beneficiary's condition is such that they require further treatment."
CMS has issued similar reports in the past, such as the Resource-Based Relative Value Scale (RBRVS) feedback reports. Safeguard will continue to send out CBRs each month.