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Claim denials related to modifiers are one of the top resolvable denials we’ve seen across the providers we work with. When you’re focused on delivering quality patient care, it’s easy to overlook the complex modifier requirements associated with Medicare reimbursements. This is especially true for the KX modifier, a two-character code used to indicate a particular service or therapy is medically necessary and exceeds the annual threshold established by Medicare. Without an effective process for KX modifier application, claims for PT, OT, and SLP services beyond Medicare’s annual limits are denied, creating unnecessary administrative burden and delayed payments for practices. To help providers stay ahead of modifier requirements, we built an automated KX Modifier assistant directly into Air. This AI-powered automation intelligently applies KX Modifiers to claims that have surpassed Medicare’s therapy thresholds, ensuring submissions are complete from the start. By automating this critical but often overlooked step, Air frees providers from the burden of applying KX Modifiers to claims and minimizes undue denials.

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How does the Air KX Modifier work?

Once a provider has opted into KX Modifier auto-application and the right conditions apply, Air appends the modifier to claims for qualifying therapy services. The modifier works seamlessly alongside other therapy modifiers (GP/GO/GN), ensuring complete compliance without disrupting your existing workflows.

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Setting automatic thresholds on a per-patient level

Air automatically monitors each Medicare patient’s therapy spending across two separate “buckets”:
• Physical Therapy + Speech-Language Pathology (combined threshold)
• Occupational Therapy (separate threshold)The system tracks deductible and coinsurance amounts toward these thresholds throughout the calendar year, giving real time visibility into exactly where each patient stands.To adjust an automatic threshold:
  1. Navigate to EHR > Calendar and click any calendar cell
  2. Expand Appointment Details and find “Medicare Threshold Remaining”
  3. Modify the threshold value according to your needs
  4. See updated calculations instantly - like “$390.00 Medicare Threshold Remaining (PT/SLP)”
Watch this in action in the demo below:

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Setting KX Modifier traits on a template

For even smarter automation, Air can evaluate KX modifier needs at the template level to:
  • Create paragraph answer/response templates with built-in KX modifier traits for validations
  • Enable threshold-based automation for targeted modifier application
  • Link appointment type to auto-applied modifiers for easy application across similar visits
  • Add Validation Steps through chart note validation reminders before finalization
Watch this video see how to link modifier traits to templates and appointment types

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Validating the KX Modifier

To validate a KX modifier that has been applied to chart note, simply navigate to the chart note and look for validations under the Notarize section. If validation is needed:
  1. Answer all the required questions
  2. Ensure the trait has been set to “valid”
  3. Review the chart and validate the reason for treatment beyond a threshold.
Watch this video to learn how to validate modifiers in Air with just a few clicks:

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The Impact You’ll See with the Automated KX Modifier

Compliance Confidence: Built-in validation ensures you’re meeting Medicare requirements without the guesswork.Revenue Protection: Never lose another therapy claim to missing KX modifiers. Air catches every threshold exceedance automatically.Staff Efficiency: Eliminate manual threshold tracking and modifier application. Your team focuses on patient care, not billing compliance.

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Getting Started Is Simple

Ready to stop losing revenue to modifier mistakes? The KX Modifier is available now in Air and requires zero additional setup time. Contact the Athelas team today to see how automated KX modifiers can protect your therapy revenue and simplify your billing workflows.  Schedule a demo today.