2021 Outpatient PT/OT Modifiers
The table below shows which PT/OT modifiers are required by specific payers for 2021. For example, traditional Medicare requires the KX, GP, GO, CQ and CO modifiers while UHC only requires the GP and GO modifiers.
The threshold for the KX modifier has been increased to $2,110 for 2021. This $2,110 threshold will cover approximately 21 PT and/or OT visits.
| Traditional Medicare | UHC (MA and CM) | Humana | Tricare | Notes |
| KX | NA | NA | NA | Add KX if a patient’s combined 2021 PT and speech therapy expenses exceed $2,110 |
| KX | NA | NA | NA | Add KX if a patient’s 2021 OT expenses exceed $2,110 |
| GP | GP | NA | NA | For all PT services |
| GO | GO | NA | NA | For all OT services |
| CQ | NA | CQ | CQ | For all procedures provided by PTAs |
| CO | NA | CO | CO | For all procedures provided by COTAs |
Key
MA=Medicare Advantage
CM=Commercial
NA=Not applicable
