Competitive Bidding - Non-Contract Exceptions - Physicians and Other Treating Practitioners, Physical Therapists, and Occupational Therapists

There are some exceptions for Non-contract suppliers that are listed below. Suppliers should refer to the fact sheets available on the CMS website for more information.

Modifiers that are appended to claims should follow the Local Coverage Determination (LCD).

For Physicians/Practitioners and Physical and Occupational Therapists the additional modifiers below should also be appended in the following situations:

  • When providing brace as part of professional service in beneficiary’s CBA (must be same date of service)
  • Beneficiary travels to non-CBA for procedure (surgery) and then goes home (KT not applicable)
  • Beneficiary temporarily living in another CBA or non-CBA (KT not applicable)

Physicians/Practitioners - KV
Physical Therapists and Occupational Therapists - J5


Last Updated Fri, 23 Apr 2021 20:34:14 +0000