Modifier KX

Requirements specified in the applicable Local Coverage Determination (LCD) have been met

Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item. Documentation must be available upon request.

It is recommended for suppliers to obtain a working knowledge of specific documentation requirements for specific medical policy prior to appending KX modifier as this will help prevent unnecessary rejected or denied claims.

Correct Use

  • When additional documentation is available to support medical necessity of item

Exception

  • Glucose Monitors and Testing Supplies LCD Documentation Requirements specifies that the KX modifier must be appended to all claims for Glucose Monitors and Testing Supplies when beneficiary is being treated with insulin injections
    • If beneficiary is not being treated with insulin injections, KX modifier should not be appended

Incorrect Use

  • Append KX modifier to claim without verifying coverage criteria and existence of documentation

Appeal Option

  • Denied claims requiring a change specific to KX modifier, whether it be adding or removing it, must be requested via Written Redetermination only
  • There are no appeal rights allowed for unprocessable claims with remark code MA130. Such claims must be corrected and resubmitted

Resources

  • Active Local Coverage Determinations (LCDs)
    • 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 and Accessories
    • Immunosuppressive Drugs
    • Knee Orthoses
    • Manual Wheelchair Bases
    • Nebulizers
    • Negative Pressure Wound Therapy Pumps
    • Oral Antiemetic Drugs
    • Orthopedic Footwear
    • Patient Lifts
    • Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea (Formerly CPAP)
    • Power Mobility Devices
    • Pressure Reducing Support Surfaces - Group 1
    • Pressure Reducing Support Surfaces - Group 2
    • Pressure Reducing Support Surfaces - Group 3
    • Refractive Lenses
    • Respiratory Assist Devices
    • Speech Generating Devices
    • Therapeutic Shoes for Persons with Diabetes
    • Transcutaneous Electrical Nerve Stimulators (TENS)
    • Urological Supplies
    • Walkers
    • Wheelchair Options/Accessories
    • Wheelchair Seating
  • Supplier Manual

 

Last Updated Fri, 04 May 2018 12:59:23 +0000