Correct Use of the KX Modifier During the COVID-19 PHE

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.

Publication History

Date of Change Description
05/14/20 Originally Published

 

Last Updated Thu, 14 May 2020 12:25:51 +0000