Medicare Therapy KX Modifier Threshold Tracking

Track cumulative Medicare therapy charges against the annual threshold, flag when the KX modifier is needed, and document claim review details to reduce denial risk.

Beneficiary and Episode Details

• Beneficiary Identifier
  Use your internal patient or account identifier. Do not enter full Medicare ID unless required by policy.
• Therapy Discipline
• Episode Start Date
  Date the therapy episode began for threshold tracking.
• Date of Service
• Place of Service

Charge and Threshold Tracking

• Current Claim Charge Amount
  Enter the charge amount for this claim line or encounter.
• Cumulative Year-to-Date Therapy Charges
  Total Medicare therapy charges accumulated for the beneficiary this calendar year before this claim.
• Applicable Annual Threshold Amount
  Enter the current threshold amount used by your organization for Medicare therapy tracking.
• Threshold Status
• Date Threshold Was Exceeded

KX Modifier Decision

• Is the KX Modifier Required for This Claim?
• Was the KX Modifier Applied?
• Medical Necessity Summary
  Briefly document the clinical rationale supporting continued therapy and the KX modifier.
• Supporting Documentation Available?
• Supporting Documentation Types

Claim Review and Audit Trail

• Review Status
• Exception Reason
• Reviewed By
  Enter the name or internal identifier of the reviewer.
• Review Date