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The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2024 therapy services KX Modifier threshold amounts. The CY 2024 amounts are as follows:

  • $2,330 for physical therapy (PT) and Speech-language Pathology (SLP) services combined; and
  • $2,330 for occupational therapy service.

Additional information can be found on the following web pages:

The Independent Regulatory Review Commission (IRRC) recently posted a proposed regulation from the Pennsylvania Department of State on behalf of the State Board of Physical Therapy (PT) for consideration.

The State Board of Physical Therapy (Board) proposes to amend §§ 40.1, 40.14, 40.15, 40.61, 40.63, 40.67, 40.163, 40.164, and 40.192. The proposed rulemaking will allow physical therapist (PT) students and physical therapist assistant (PTA) students to sit for the requisite examinations up to 90 days prior to graduation from their respective programs, and it will allow PTs and PTAs to receive a limited amount of continuing education credit for providing clinical instruction to student PTs and student PTAs at clinical facilities affiliated with accredited programs. Additionally, the proposed rulemaking will allow applicants to directly register for the national examination with the examination provider, by removing the requirement that the applicant first seek the Board’s permission. Lastly, it will allow applicants to sit for a third or successive examination, after two failures, without first seeking the Board’s permission.

The amendments will be effective upon notice or publication of the final-form rulemaking in the Pennsylvania Bulletin scheduled for January 27, 2024. The proposed regulation will be open for public comment upon publication, and comments will be accepted through February 26, 2024. Written comments, recommendations, or objections regarding this proposed rulemaking should be sent to Thomas M. Davis, Board Counsel, at P.O. Box 69523, Harrisburg, PA 17106-9523 or by email within 30 days of publication of this proposed rulemaking in the Pennsylvania Bulletin. Please reference “Regulation No. 16A-6522 (Early Exam, CE for Clinical Instruction, and AAP)” when submitting comments. IRRC comments on the proposed regulation will be due by March 27, 2024.

The Centers for Medicare and Medicaid Services (CMS) has updated the calendar year (CY) 2023 per beneficiary threshold amounts for therapy services. These threshold amounts, also known as therapy caps, are reflected on claims with the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. There is one amount for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined and a separate amount for Occupational Therapy (OT) services. Claims from providers for therapy services above the threshold amounts without the KX modifier are denied.

For CY 2023, the KX modifier threshold amounts are: (a) $2,230 for PT and SLP services combined, and (b) $2,230 for OT services.

For additional information, refer to CMS Transmittal 11626 and the 2023 Therapy Code List and Dispositions.