Medicare therapy cap changes effective Jan. 1, 2022

Starting Jan. 1, 2022, we're making changes to our Medicare therapy caps for physical, occupational and speech therapies (PT/OT/ST). We're making these changes based on recent changes from the Centers for Medicare and Medicaid Services (CMS), and to align with their guidelines.

What’s changing?

The following guidelines apply for claims received beginning Jan. 1, 2022: 

  • Providers need to track member's therapy services to $2,150.
  • Claims received between $2,150 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 record review. 

For additional information about Medicare therapy cap limits and CMS' position, reference Therapy Services Spotlight