Question

Which modifier is used for showing care is reasonable and necessary after therapy cap is reached?

a) Modifier KX
b) Modifier GA
c) Modifier GY
d) Modifier QW

Answer 1

Modifier KX is used for showing care is reasonable and necessary after therapy cap is reached, indicating that treatment is necessary even if the cap has been exceeded.

Step-by-step explanation:

The correct modifier for showing care is reasonable and necessary after the therapy cap is reached is Modifier KX. This modifier is used to indicate that treatment is necessary, even if the cap has been exceeded. It helps to ensure that payment for the therapy services is not denied.

For example, let's say a patient has reached their therapy cap for the year, but they still require additional therapy due to their medical condition. In this case, the healthcare provider would use Modifier KX when submitting the claim to indicate that the therapy is medically necessary.

Modifiers GA, GY, and QW are used in different contexts and do not apply to this particular situation.