What can offices do if they receive a denial for VHT with the reason “Maximum Benefit Reached”?

What can offices do if they receive a denial for VHT with the reason “Maximum Benefit Reached”?

In some states Medicare considers 97610 a “sometimes therapy code” and patients have a maximum amount allowed per year for therapy. Once this cap is met, 97610 can still be billed but a KX modifier must be added to the claim to show medical necessity.  Denied claims with this reason can be resubmitted with this modifier for payment.  Offices would then continue to use this modifier for future 97610 claims.  ***This is not a modifier that all offices should start automatically putting on their claims. This is only to be used if the claim is denied for Maximum Benefit Reached.***