CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) APPROVED RAC ISSUE: 0228
May 19th, 2026
CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) APPROVED RAC ISSUE: 0228 THERAPY CLAIMS WITH KX MODIFIER
CMS recently approved a RAC complex review audit targeting outpatient PT, OT, and ST claims billed with the KX modifier.
WHAT YOU NEED TO KNOW
Performant RAC Detailed Review Focus:
- Confirm appropriate use of KX modifier
- Required when incurred expenses exceed a beneficiary’s annual threshold of $2480 for OT, or $2480 PT+SLP
- Verify outpatient therapy meets Medicare coverage criteria and coding guidelines
- Ensure medical necessity and continued services are justified and supported by documentation
Additional information can be located on this page at the Performant website.
Preferred Therapy Solutions continues to provide vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported by compliance and regulatory requirements that are necessary for a thorough understanding of practices and procedures. If you have any questions, contact Barbara Blatt, Director of Quality and Appeals Management at bblatt@preftherapy.com.
Posted in the categories Compliance, News.
