CMS Clarifies Use of the KX Modifier for Therapy Cap Exception Claims
The Centers for Medicare and Medicaid Services (CMS) has issued a temporary "workaround" solution to resolve recent problems caused by a software flaw in the fiscal intermediary claims filing system (FISS system) for billing the KX modifier for therapy cap exceptions.
In summary, occupational therapy claims should be billed as follows:
- When providers submit claims with multiple line items for occupational therapy services, the presence or absence of the KX modifier on the physical therapy/speech-language pathology line items does not affect the use of the KX modifier for occupational therapy services.
- Apply the KX modifier to all of the occupational therapy line items if
- all of the line items would represent services that are appropriate for use of the KX modifier if the services exceeded the cap; and
- some of the lines represent services that are currently eligible for use of the KX modifier on this claim.
- Or, apply the KX modifier to none of the occupational therapy line items, if appropriate.