Medicare deductible and coinsurance
Part A
| Year | Inpatient hospital deductible | Hospital coinsurance for days 61-90 | Hospital coinsurance for days 91-150 (lifetime reserve) | Skilled nursing facility days 21-100 |
|---|---|---|---|---|
| 2026 | $1,736 | $434 | $868 | $217 |
| 2025 | $1,676 | $419 | $838 | $209.50 |
| 2024 | $1,632 | $408 | $816 | $204 |
Part B
| Year | Deductible | Coinsurance |
|---|---|---|
| 2026 | $283 |
20 percent of the Medicare allowed amount/fee schedule |
| 2025 | $257 |
20 percent of the Medicare allowed amount/fee schedule |
| 2024 | $240 |
20 percent of the Medicare allowed amount/fee schedule |
KX modifier thresholds
| Year | PT/SLP Cap | OT Cap |
|---|---|---|
| 2026 | TBD | TBD |
| 2025 | $2,410 | $2,410 |
| 2024 | $2,330 | $2,330 |
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.
Additional details available on CMS’ therapy services page
References
- 2026 Medicare Parts A & B Premiums and Deductibles
- Medicare Deductible, Coinsurance, & Premium Rates: CY 2025 Update
- Medicare Deductible, Coinsurance, & Premium Rates: CY 2024 Update