KX Modifier Temporary Fix


By:Jacqueline Thelian, CPC, CPC-I, CHCA

Did CMS reinstate the use of the KX Modifier for therapy claims? Yes and No. CMS implemented a temporary fix.

Despite Congressional failure to remove the cap exception, on January 28, 2018 CMS announced they will start to pay claims submitted with the KX modifier (Requirements specified in the medical policy have been met).

Starting January 25, 2018, CMS will immediately release for processing held therapy claims with the KX modifier with dates of receipt beginning from January 1-10, 2018.  Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis.

At the same time, CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold” of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted.

CMS did not indicate if this temporary fix will continue until Congress can get the cap extension reinstated. 

For further updates please go to CMS All Fee For Services Providers Page https://www.cms.gov/Center/Provider-Type/all-fee-for-service-providers-center.html