Free tool · 2026 thresholds
KX modifier threshold calculator
See how close a patient is to the 2026 KX threshold and the medical review threshold, and how many visits remain before each.
This patient, 2026
Under $2,480. No KX modifier is needed yet. $630 remains before it is required.
Physical therapy and speech-language pathology share one amount. Thresholds apply per patient per calendar year, across all providers. Use the allowed amount, not your billed charge.
Questions
What is the KX threshold for 2026?
$2,480 for physical therapy and speech-language pathology combined, and $2,480 for occupational therapy, per patient for calendar year 2026.
What is the medical review threshold for 2026?
$3,000 for PT and speech combined, and $3,000 for OT. Claims above it may be selected for targeted medical review.
What does the KX modifier mean?
It confirms that services above the threshold are medically necessary and that the medical record supports this. Without it, claims above the threshold are denied.
Is there still a therapy cap?
No. The hard cap was repealed in 2018. The amount remains as a threshold above which the KX modifier is required.
What about services from therapy assistants?
Services provided in whole or in part by a PT or OT assistant carry the CQ or CO modifier and are paid at 85% of the usual amount.
This tool gives information, not billing or legal advice. Year-to-date amounts across all providers are available from your Medicare eligibility check.