Medicare used to have a limit on the amount of physical therapy that it would cover in a year, but this limit was lifted in 2018. This means that you can now have as much physical therapy as is medically necessary each year, without having to worry about running out of coverage.
However, Medicare does have a KX modifier threshold for physical therapy services. This means that if your physical therapy costs exceed a certain amount in a year, your claims may be subject to additional review to ensure that the services are medically necessary. The KX modifier threshold for 2023 is $2,230 for physical therapy and speech therapy services combined.
If your physical therapy costs exceed the KX modifier threshold, your physical therapist will need to bill Medicare with a KX modifier on all subsequent claims. This modifier tells Medicare that the services are medically necessary and that you have met the threshold.
Even if your physical therapy costs exceed the KX modifier threshold, you will still be covered for medically necessary services. However, you may be responsible for paying a higher share of the cost.
If you have any questions about your Medicare coverage for physical therapy, be sure to talk to your doctor or physical therapist.
