2021 Outpatient PT/OT Modifiers

January 21, 2021
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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


MA=Medicare Advantage
NA=Not applicable