Modifiers KB and 99

Original Effective Date: 02/17/2003
Revision Effective Date: 11/01/2013

The DMERC claims processing system accommodates up to 4 modifiers per line item. Because the DMERC recognizes there are some claim situations when more than 4 modifiers may be required on a given claim line, effective for claims processed on or after July 1, 2003, two new modifiers have been created and must be used according to the following instructions:

Beneficiary-Requested DME Upgrade: Aside from modifiers required for proper billing, suppliers must also use two of three modifiers (either GZ or GA, and GK) with a beneficiary-requested DME upgrade. (See the Winter 2002 DMERC Dialogue, page 18 for more information on correct usage of these modifiers.) In cases when billing for a beneficiary-requested upgrade and more than four modifiers are necessary the following new modifier must be used:

  • KB - Beneficiary requested upgrade for ABN, more than 4 modifiers identified on claim

All Other Situations: For any other situation where more than four modifiers are needed, suppliers must use the following new modifier:

  • 99 - Modifier overflow

For paper claims, when a supplier must use more than 4 modifiers, the supplier must append modifier KB or 99 to the HCPCS code following the required modifiers for the code.

Example: Supplier needs to bill E0277RRKJKXBPGA

On the claim line the supplier should enter E0277RRKJKXKB or E0277RRKJKX99 (whichever is applicable). Modifiers BP and GA should be entered in block 19 of the CMS-1500 claim form.

For electronic claims in the National Standard Format (NSF), when a supplier must use more than 4 modifiers, the supplier must append modifier KB or 99 to the HCPCS code following the required modifiers for the code.

Example: Supplier needs to bill E0277RRKJKXBPGA

On the claim line the supplier should enter E0277RRKJKXKB or E0277RRKJKX99 (whichever is applicable). Modifiers BP and GA should be entered in the HA0 record per claim line.
For electronic claims in the American National Standards Institute (ANSI) X12N format, when a supplier must use more than 4 modifiers, the supplier must append modifier KB or 99 to the HCPCS code following the required modifiers for the code.

Example: Supplier needs to bill E0277RRKJKXBPGA

On the claim line the supplier should enter E0277RRKJKXKB or E0277RRKJKX99 (whichever is applicable). Modifiers BP and GA should be entered in 2400-NTE02 (NTE01+ADD).

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