This topic contains 1 reply, has 1 voice, and was last updated by  Jennifer Searfoss 4 months, 2 weeks ago.

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     Jennifer Searfoss 

    SCG Staff

    On November 1, 2018 the Centers for Medicare & Medicaid Services published the 2019 final Medicare Physician Fee Schedule. Jen Searfoss covered this in a live webinar on November 27, 2018. Please post questions about the 2019 fee schedule and QPP Year 3 policy changes here so that everyone has access to the answers!

    Correct PDF of the final rule published in the Federal Register

    2019 Medicare Physician Fee Schedule Impact Charts

    2019 MPFS Impact Charts for E/M changes in 2021

    Slides for the 2019 Medicare Physician Fee Schedule Highlights Webinar

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     Jennifer Searfoss 

    SCG Staff

    Question: What is the annual update and how does the KX modifier get used in 2019?

    For physical therapy and speech-language pathology, the therapy combined cap in 2019 is: $2,040
    For occupational therapy (alone), the therapy cap in 2019 is: $2,040
    The targeted medical review threshold is likely $3,000 (there is no update stated in the fee schedule): “For CY 2018, the MR threshold is $3,00 for PT and SLP services combined and $3,000 for OT services.” 83 Fed Reg 59661.
    Under the Bipartisan Budget Act of 2018 (and the proceeding litigation on coverage), there are no longer hard caps for therapy coverage.

    CMS considers this amount the “KX Modifier threshold”. The annual update includes adjustment for the Medicare Economic Index (MEI) of 1.5% for 2019 and rounds to the nearest $10 increment. This results in an increase of $30. In 2018, the therapy caps was $2,010 for each cap.

    2019 Medicare Physician Fee Schedule Final Rule – therapy discussion begins on page 393 of the PDF, 83 Fed Reg 59654-59661
    CMS resource:

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