Medicare therapy cap changes effective Jan. 1, 2024

Starting Jan. 1, 2024, we're changing our Medicare therapy caps for physical, occupational and speech therapies (PT/OT/ST). We're making these changes to align with recent guideline updates from the Centers for Medicare and Medicaid Services (CMS).

What's changing?

The following guidelines apply for claims received beginning Jan. 1, 2024:

• Providers need to track members' therapy services to $2,330 for PT/SLP services combined and $2,330 for OT services.
• Claims between $2,330 and $3,000 must include the KX modifier to be paid
• Claims received at $3,000 or greater must include the KX modifier, and you'll be notified if chosen for a targeted medical review

For additional information about the Medicare KX modifier, reference this CMS Manual System document.