Medicare therapy cap changes effective Jan. 1, 2025
Starting Jan. 1, 2025, we're changing our Medicare therapy caps for physical, occupational and speech therapies (PT/OT/ST). We're making these changes to align with recent guideline updates from the Centers for Medicare and Medicaid Services (CMS).
What's changing?
The following guidelines apply for claims received beginning Jan. 1, 2025:
- Providers need to track members' therapy services to $2,410 for PT/ST services combined and $2,410 for OT services.
- Claims between $2,410 and $3,000 must include the KX modifier to be paid.
- Claims received at $3,000 or greater must include the KX modifier, and providers will be notified if chosen for a targeted medical review.