CMS releases update on therapy caps and functional reporting

Updates to Reflect Removal of Functional Reporting Requirements and Therapy Provisions of the Bipartisan Budget Act of 2018.

Therapists must continue to track their patients’ utilization toward the threshold and attach the KX modifier to all claims for therapy services that are medically necessary that exceed the annual threshold amount (in 2019, the threshold is $2,040 for PT and SLP services combined and $2,040 for OT services). Claims that exceed $3,000 in total are subject to a targeted medical review. This change is effective for dates of service on or after January 1, 2019.

HCPCS G-codes and severity modifiers for functional reporting are no longer required on claims for therapy services. 

Billing staff should be aware of these changes effective January 1, 2019.