PT services see high denial rates for electrical stimulation, other techniques

The following graphs depict claims denial trends for therapy services listed on CMS’ “always therapy” code list that were billed in 2010 and 2011. These codes are eligible for the therapy cap rule, which requires use of the KX modifier (Requirements specified in the medical policy have been met) when therapy services for a single patient exceed $1,900 (PBN 1/14/13).

Note: Claims billed with the KX modifier were not included in the analysis because the modifier became active Jan. 1, 2011, and was not listed in CMS’ claims database. (Visit www.cms.gov/Medicare/Billing/TherapyServices/AnnualTherapyUpdate.html to download the full “always therapy” list. Look for more about the therapy cap in an upcoming issue of Part B News.)