Workers' Compensation Experience Mod (EMR) & Premium Impact Estimator
Pull W, ballast and expected losses straight off your bureau rating worksheet, add your actual primary/excess losses, and see the estimated mod - plus what each 0.10 of mod does to next year's premium.
The Experience-Rating Formula, In Plain Language
Experience rating compares your actual losses with the expected losses for your class and payroll over a three-year experience period (normally excluding the most recent policy year). Losses are split at your state's split point into primary losses (weighted fully - they signal frequency) and excess losses (weighted by the worksheet's W value - they signal severity). The stabilizing/ballast value keeps small employers' mods from swinging wildly. A mod of 1.00 is the class average; 0.80 means a credit of roughly 20% against manual premium, 1.20 a debit of roughly 20%. Independent-bureau states (for example California's X-Mod) use their own plans - use that bureau's worksheet values here.
KX modifier threshold: have you crossed $2,480 this year?
For CY 2026 the KX threshold is $2,480 for PT and SLP combined and $2,480 separately for OT (CMS Therapy Services CY 2026 update; re-confirmed at each November re-check). Crossing it is not a cap and not permission: append KX only on claims where continued therapy is medically necessary and the record documents it. The year-to-date fields in the allocator above run this check on every calculation.
Frequently Asked Billing Questions
Why is my estimate different from the mod on my policy?
The bureau mod uses audited payroll, bureau expected loss rates, your state's split point and the exact W and ballast from its rating worksheet, plus any rating adjustments. This estimator is only as accurate as the worksheet values you type in - enter those, and it should land close; it can never issue the official figure.
Related Medical Coding & Unit Calculators
Free JW/JZ calculator: enter dose, vial size and HCPCS unit to get exact Medicare claim lines, including the sub-unit trap where JW is prohibited and JZ is required.
99417 vs G2212 TimeEnter total minutes: see instantly whether AMA CPT pays 99417 or 99292 and where CMS Medicare denies it (G2212 at 89/69 min, 99292 at 104 min). Free, no sign-up.
Anesthesia UnitsCalculate anesthesia base + 15-minute time units for Medicare ($20.4976, 0.1 rounding, no P-status) vs commercial payers, with AA/QK/QX/QY/QZ direction splits.
PT/OT 8-Min & CQ/COPool timed minutes across CPT codes the CMS way, compare AMA per-code units, and flag CQ/CO when a PTA/OTA passes 10%. Free therapy allocator with audit note.
NDC 10→11 ConverterConvert FDA 4-4-2, 5-3-2 and 5-4-1 package NDCs to the 11-digit 5-4-2 claim format with NCPDP quantity and Loop 2410 LIN/CTP output. Rejects unhyphenated codes.
Global PeriodEnter a surgery date and CMS global indicator (000/010/090) to get the exact global window, then decide modifiers 24/25/57/58/78/79 with a copy-ready audit note.
PBM Days' SupplyCalculate audit-defensible days' supply for tablets, insulin pens (with your PBM priming units), eye drops (your drops/mL) and inhalers. Formulas only, no hidden PBM values.
Infusion TimeTurn documented infusion minutes into initial, additional-hour, sequential and concurrent units for chemo, therapeutic and hydration families, with the >30-minute rule applied.
CCM / TCMAdd monthly care-management minutes to reach 99490, 99491 or complex CCM thresholds, or enter a discharge date for TCM contact and 7/14-day visit deadlines (CMS MLN).
Therapy MPPREstimate the CMS multiple procedure payment reduction on same-day therapy: highest-PE unit paid in full, PE of later units halved. Work and malpractice never reduced.
Mod 51 / 50 PayEstimate Medicare multiple-procedure pricing (100%/50%) and bilateral surgery payment by MPFS indicator (150%, 100% or already-priced) with modifier 51/50 claim notes.