First Coast Service Options Inc. (FCSO’s) performed analysis on the use of the KX modifier. Data indicates a pattern where some providers are submitting the KX modifier prior to the beneficiary’s therapy cap being reached. For the first month of calendar year 2012, some providers are appending the modifier on all submitted therapy services. Excessive use of the KX modifier may indicate abusive billing.
The KX modifier added to a service is attesting that:
• The service was medically necessary and it is justified by the medical documentation
• The physical therapy financial limitation cap was met, and
• The patient’s condition requires further treatment.
Continued abuse of the KX modifier may result in a provider-specific probe to review the medical documentation on a randomly selected sample of beneficiaries who had these procedures performed
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