CPAP Documentation And KX Modifier Usage

Original Effective Date: 09/06/2002
Revision Effective Date: 11/01/2013

Recently, the local medical review policy on CPAP devices was published and included documentation requirements for the use of the KX modifier. Questions have arisen regarding the use of the KX modifier for beneficiaries with CPAP therapy initiated prior to the July 1, 2002 effective date of the policy.

The policy stipulates that in order to use the KX modifier for the fourth month's claim and any month thereafter, evidence of continued use of the device must be obtained from either the beneficiary or the treating physician. Therefore, regardless of the start date of CPAP therapy, in order to bill Medicare and use the KX modifier, suppliers must ascertain that the beneficiary is continuing to use the CPAP device. The requirement to verify a beneficiary's continued use of capped rental equipment prior to billing the DMERC is not new or unique to the CPAP policy, but rather applies to all items in the capped rental payment category. This documentation does not have to be submitted with the claim but must be retained in the supplier's files and be made available to the DMERC upon request.

Last Updated May 05 , 2017