Changes to therapy billing with the end of the therapy cap!

Earlier this morning, therapists had a victory with the permanent repeal of the Medicare therapy cap. This is a huge victory for associations such as the APTA and the AOTA, and comes after over two decades of lobbying for change. The repeal of the therapy cap ensures patients who need physicial therapy, speech therapy, and occupational therapy services can receive it without the fear of being denied after reaching a threshold cap. There was also a bit of dissapointing news with the addition of a 15% reduction in reimbursement for outpatient services provided by therapists. The reduction is not slated to take effect until 2022,

The KX modifier, which has been in place for years, and designates "medical necessity" will still be required to be used for claims exceeding $2,010 in a year. This amount

will increase annually. The new law now states that for charges exceeding $3,000 in a year there will be a manual review, but not all claims above the $3,000 limit will actually be reviewed. Only those providers with abnormalities such as high rate claims denial or abnormal billing pattersn would most likely be targeted for review. For the purpose of the KX modifier and medical review threshold, PT and SLP will still be bundled.


  • There is no more hard cap.

  • The KX modifier still needs to be appended if therapy charges exceed $2,010 in the year..

  • Claims exceeding $3,000 could be subject to a manual medical review.

  • You do not need to send records unles requested by Medicare.

  • Even after 2022, therapy by PTA's will still be reimbursed by Medicare.

  • Changes effect PTA's reimbursement under the Medicare Part B Physician Fee Schedule starting in 2022.

  • Reimbursement in inpatient settings or under alternative payment models is not affected.

  • Commercial insurance reimbursement is not directly affected, however usually Medicare sets the trends in reimbursement for commercial carries. AMBS will keep you updated as more information is released. If you are a therapy provider, AMBS specializes in outpatient rehabilitation therapy and would love to show you how we can maximize your revenue. Contact us for more information and setup your free, no obligation consultation!

#AMBS #PhyscialTherapyBilling #OccupationalTherapyBilling #MedicareTherapyCap #BillingforTherapyServices #SpeechTherapyBilling #Therapyservices #OutpatientTherapyBilling #PracticeManagement #MedicalBillingServices #Medicareclaims #MedicareReimbursement

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