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Resources: Kentucky Medicaid Claims and Denials, Therapy Services & KX-Modifiers

Posted by Admin Posted on Dec 22 2023

Kentucky Medicaid Claims and Denials

Many clients have recently mentioned Medicaid claim denials. Many of the denials are related to the Recertifications process.

Some denial reasons are as follows:

•       Patient liability missing on KYMMIS

•       Incorrect program code (Managed Care listed vs LTC)

•       Incorrect Eligibility Group (Global Choices vs Comprehensive Choices)

While there are multiple denial issues we have been instructed by Department for Medicaid services to have providers email the issues to:

If you are erroneously getting Kentucky Medicaid claims denied with reason code 4227 - “REVENUE CODE IS NOT COVERED FOR THIS MEMBER”, you should email the following to get the Program code fixed:


Therapy Services

Supervision Policy for Physical and Occupational Therapists in Private Practice Since 2005, we’ve required PTs Private Practices and OTs Private Practices (PTPPs and OTPPs, respectively) to provide direct supervision of their therapy assistants. We’re finalizing a regulatory change to allow for general supervision of therapy assistants by PTPPs and OTPPs for remote therapeutic monitoring (RTM) services, starting January 1, 2024.

Click here to learn more.


KX Modifiers

The KX-modifier threshold amounts for CY 2024 are $2,330 for OT services and $2,330 for PT and SLP services combined.

Click here to learn more.


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