RETIRED - Correct Use of the KX Modifier During the COVID-19 PHE - JA DME

Joint DME MAC Bulletin Article

Effective for claims with dates of service on or after March 1, 2020 and for the duration of the COVID-19 Public Health Emergency (PHE), for the following LCDs in which the Face-to-Face evaluation or other services with an implied Face-to-Face evaluation such as a home assessment are waived during the PHE, the supplier must append the KX modifier if all other requirements specified in the policy are met:

• Knee Orthoses (L33318)
• Manual Wheelchair Bases (L33788)
• Negative Pressure Wound Therapy Pumps (L33821)
• Power Mobility Devices (L33789)^*
• Pressure Reducing Support Surfaces - Group 1 (L33830)
• Pressure Reducing Support Surfaces - Group 2 (L33642)
• Pressure Reducing Support Surfaces - Group 3 (L33692)
• Speech Generating Devices (SGD) (L33739)
• Tumor Treatment Field Therapy (TTFT) (L34823)
• Urological Supplies (L33803)
• Wheelchair Options/Accessories (L33792)
• Wheelchair Seating (L33312)

*For Power Mobility Devices (PMDs), the face-to-face encounter with the ordering practitioner is mandated by Medicare statute at section 1834(a)(1)(E)(iv) of the Social Security Act, as codified in 42 CFR § 410.38. The regulation already permits the use of telehealth in accordance with Medicare guidelines. CMS has extended flexibilities to permit a broader use of telehealth services, locations, provider types and technologies during the COVID-19 PHE.

For the following LCDs, the supplier must append the KX modifier if all the requirements specified in the policy are met:

• Ankle-Foot/Knee-Ankle-Foot Orthosis (L33686)
• Automatic External Defibrillators (L33690)
• Cervical Traction Devices (L33823)
• Commodes (L33736)
• Glucose Monitors (L33822) - with the exception of CGM as noted below
• Hospital Beds And Accessories (L33820)
• Immunosuppressive Drugs (L33824)
• Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) (L33827)
• Orthopedic Footwear (L33641)
• Patient Lifts (L33799)
• Refractive Lenses (L33793)
• Transcutaneous Electrical Nerve Stimulators (TENS) (L33802)
• Walkers (L33791)

Additionally, suppliers should continue to bill the KX and/or CG modifiers for which LCDs' clinical indications of coverage are not being enforced. For those LCDs listed below, application of the KX or CG modifier attests that a Standard Written Order (SWO) is on file for the item and the medical record supports the item is reasonable and necessary:

• Oxygen and Oxygen Equipment (L33797)
• Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea (L33718)
• Oral Appliances for the Treatment of Obstructive Sleep Apnea (L33611)
• Respiratory Assist Devices (L33800)
• Mechanical In-exsufflation Devices (L33795)
• High Frequency Chest Wall Oscillation (L33785)
• Nebulizers (L33370)
• Glucose Monitors (L33822) - Only clinical indications for Therapeutic Continuous Glucose Monitors (CGM) are not enforced
• External Infusion Pumps (L33794)

Suppliers are reminded to append a CR modifier and include a narrative of "COVID-19" to all claims that are affected by the COVID-19 PHE. The narrative should be entered into the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format, field 390-BM of the National Council for Prescription Drug Program (NCPDP) format, or Item 19 of paper claims.

This enforcement discretion will only apply during the PHE for the COVID-19 pandemic. At the conclusion of the PHE for the COVID-19 pandemic, the DME MACs will return to enforcement of these requirements.

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