Immunosuppressive Drugs Billing Reminder

Suppliers are reminded that a Medicare approved transplant must be in the Medicare claim database for immunosuppressive drugs to be paid. If the transplant cannot be located in the claims database, suppliers should bill with the KX modifier to notify Medicare that documentation is on file.

Documentation must include:

  • Date of transplant
  • Medical necessity for services furnished
  • Beneficiary Medicare Part A eligibility at time of transplant
  • Medicare paid for transplant in accordance with statute

The date of the transplant must precede the date of service on the immunosuppressive drugs claim. Suppliers must not append the KX modifier when the coverage criteria in Local Coverage Determination (LCD) L33824 have not been met.

Refer to the Noridian Immunosuppressive Drugs webpage for additional resources.

Last Updated $dateUtil.getDate( $modifieddate , "MMM dd , yyyy" , $locale , $tzone )