The KX modifier signifies that all Medicare coverage criteria for parenteral nutrition have been met. It should only be used when the beneficiary meets the following:

• Enteral nutrition has been tried and ruled out, or tried and found ineffective, or exacerbates gastrointestinal tract (GI) dysfunction
• Disease of small intestine and/or exocrine glands, or stomach and/or exocrine glands impairing nutritional absorption
• Permanent impairment as determined by treating practitioner

Required Documentation

To support the KX modifier, suppliers must have:

• A signed Standard Written Order (SWO)
• Medical records that meet the Parenteral Nutrition Local Coverage Determination (LCD) and Policy Article requirements
  • Evaluation within 30 days of parenteral nutrition therapy initiation
  • Substantiated evidence of diagnosis
• Refill requirements
• Proof of Delivery (POD) documentation

Do not use the KX modifier if any criteria are unmet; use the GA or GZ modifier instead. For more information review the HCPCS Modifier section within the policy article.