Medicare Threshold Report

Even though the Medicare Cap has officially been repealed as of February 9, 2018, PTs, SLPs, and OTs are still expected to apply the KX modifier to claims over the following threshold amounts for 2023:

  • $2,230 for PT and SLP services combined, and
  • $2,230 for OT services

Use the WebPT EMR Medicare Allowable Threshold Report to view all your Medicare patients’ progress toward this dollar amount and ensure that the KX modifier is applied accurately. Click on Medicare Threshold located under the Reports menu to access the Medicare Threshold Report on the left-hand side of the Dashboard.

Note: You will first need to set up your Medicare Fee Schedule to use the Medicare Threshold Report and turn on the Medicare Threshold Alerts to it. 

When you generate the Medicare Threshold Report, you’ll immediately see all Medicare patients progressing toward the therapy threshold for this calendar year. With this display, you can view:

  • Patient Name
  • Last Date of Service
  • The amount of the therapy threshold used vs. the amount remaining or exceeding
  • Prior therapy threshold amount used
  • Case name
  • Whether a therapist has applied the KX modifier
  • Therapist type
  • Therapist initials

Narrow your results using the Report Filters:

  1. Choose the year by using the Time Period drop-down.
  2. You can view specific a patient's overall, current, and previous therapy threshold totals. Simply type the first or last name in the Patient filter, select it from the list, and click Generate Report. 
  3. Choose the provider specialty, using the Therapist Type drop-down.
  4. You may include or exclude any KX modifiers. Select Yes to include KX modifiers or No to exclude KX modifiers from the drop-downs.
  5. Click Generate Report, to apply the filters to your report.
  6. Export to Excel or Generate a PDF of the report results.
  7. Click any patient name to access that patient’s record.
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