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Even though the Medicare Cap has officially been repealed as of February 9, 2018, PTs, SLPs, and OTs are still expected to apply the KX modifier to claims over the following threshold amounts for 2022:

  • $2,150 for PT and SLP services combined, and
  • $2,150 for OT services

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

Narrow your results using these Report Filters:

  1. Filter your results by year using the Time Period drop-down.
  2. To view patient-specific therapy cap totals: overall, current, and previous; type the first or last name and choose from the list, then click Generate Report.
  3. Select the provider specialty, using the Therapist Type drop-down.
  4. Select to Yes to include KX modifiers or No to exclude or 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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