KX Modifier Billing Reminder

Posted July 06, 2012

Supplier usage of the KX modifier identifies that the requirements identified in the medical policy have been met. Documentation is essential to support that the item is reasonable and necessary and that the specific coverage criteria specified in each policy have been met.

The KX modifier has differing requirements for usage depending on the specific Local Coverage Determination (LCD); suppliers should review the LCDs carefully to understand the documentation requirements and the proper use of the KX modifier for each policy.

Review any applicable LCDs that include the KX modifier requirement at: www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml

Below is a list of LCDs which include a KX modifier requirement for some or all items within that specific LCD. Use of the KX modifier with any other DMEPOS is inappropriate usage.

• Ankle-Foot/Knee-Ankle-Foot Orthosis

• Automatic External Defibrillators

• Cervical Traction Devices

• Commodes

• External Infusion Pumps

• Glucose Monitors

• High Frequency Chest Wall Oscillation Devices

• Hospital Beds

• Immunosuppressive Drugs

• Knee Orthoses

• Manual Wheelchair Bases

• Nebulizers

• Negative Pressure Wound Therapy Devices

• Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

• Oral Appliances for Obstructive Sleep Apnea

• Orthopedic Footwear

• Patient Lifts

• Positive Airway Pressure Devices

• Power Mobility Devices

• Pressure Reducing Support Surfaces

• Refractive Lenses

• Respiratory Assist Devices

• Speech Generating Devices

• Therapeutic Shoes for Persons with Diabetes

• Transcutaneous Electrical Nerve Stimulators (TENS)

• Urological Supplies

• Walkers

• Wheelchair Options and Accessories

• Wheelchair Seating

It is important to remember, if the requirements specified in the LCD are not met the KX modifier must not be used.

Most LCDs include a modifier which indicates the documentation requirements are not met by appending either a GA, GY, or GZ modifier if a claim is denied for missing one of these modifiers it must be resubmitted. Refer to the KX, GA, GZ and GY Modifiers - New Uses article for additional information.

Be sure to review each LCD closely to determine which modifier is appropriate when the LCD documentation requirements are not met.

            Last Updated Tue, 23 May 2017 12:21:44 +0000