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Even though the Medicare Cap has officially been repealed as of February 9, 2018, PTs, SLPs, and OTs are still expected to apply the KX modifier to any claims over $2,080. Use the Medicare Allowable Cap Report to view all your Medicare patients’ progress toward this dollar amount and ensure that the KX modifier is applied accurately. To access the Medicare Threshold Report, click on  Medicare Threshold located under Reports on the left-hand side of the Dashboard.

Note: In order to use the Medicare Threshold Report, you will first need to set up your Medicare Fee Schedule. You will also need to turn on the Medicare Cap Alerts system to be able to run this report. 

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

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

You can generate a PDF of the report as well as export the results to Excel. You can also click any patient name to access that patient’s record. You can filter your results by selecting or entering start and end dates or by using the therapist type or KX modifier drop-downs. Upon choosing your filters, click  Generate Report to view those specified results.

To search for a particular patient, enter the patient’s full name, and click Generate Report. Upon accessing an individual patient, you can view his or her overall, current, and previous therapy cap totals. Again, you can generate this data into a PDF or export it to an Excel document.