Deductibles/co-insurances/therapy thresholds

Part A (2021 - 2019)

Year

Deductible

Co-insurance

2021

1,484.00

$371.00 a day for days 61-90

$742.00 a day for days 91-150 (lifetime reserve days)

$185.50 a day for skilled nursing facility days 21-100

2020

1,408.00

$352.00 a day for days 61-90

$704.00 a day for days 91-150 (lifetime reserve days)

$176.00 a day for skilled nursing facility days 21-100

2019

1,364.00

$341.00 a day for days 61-90

$682.00 a day for days, 91-150 (lifetime reserve days)

$170.50 a day for skilled nursing facility days 21-100

Part B (2021 - 2019)

Year	Deductible	Co-insurance
2021	203.00	20 percent of the Medicare allowed amount/fee schedule
2020	$198.00	20 percent of the Medicare allowed amount/fee schedule
2019	$185.00	20 percent of the Medicare allowed amount/fee schedule

KX modifier thresholds (formerly known as therapy caps) (2021 - 2019)

Year	Therapy discipline	Cap
2021	PT/SLP	$2,110.00
	OT	$2,110.00
2020	PT/SLP	$2,080.00
	OT	$2,080.00
2019	PT/SLP	$2,040.00
	OT	$2,040.00

Section 50202 of the Bipartisan Budget Act of 2018 repeals the application of the therapy caps while also retaining and adding limitations to ensure appropriate therapy. A provision of section 50202 of the BBA of 2018 adds section 1833(g)(7)(A) of the Act to preserve the former therapy cap amounts as thresholds above which claims must include the KX modifier to confirm that services are medically necessary as justified by appropriate documentation in the medical record. These amounts are now known as the KX modifier thresholds.

The Part A deductible/coinsurance amounts and Part B deductible amounts for previous years can be found in the CMS IOM Pub. 100-01, General Information, Eligibility and Entitlement Manual, Chapter 3, Sections 10.3 & 20.2.