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20 Jan 2021

2016 Annual Update of Healthcare Common Procedure Coding System. Both modifiers cannot be used on the same claim lines. 0000002418 00000 n If the requirements for the KX modifier are not met, the KX modifier must not be used. 0000048104 00000 n trailer <]/Prev 135438/XRefStm 2241>> startxref 0 %%EOF 225 0 obj <>stream DME requires a prescription to either rent or purchase the equipment. 0000034942 00000 n No certificate of Medical necessity received. The service delivered beyond that require a KX modifier that indicates that the service meets the criteria for payment exception. 0000048553 00000 n DME written order needs to have detailed description of the item signed and dated by physician. Continued on page 52 Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare … Use of the KX Modifier for Therapy Cap Exceptions. The most DME denials in Medical billing are as follows: What is Medical Billing and Medical Billing process steps in USA? Note: The KX modifier may also be used in conjunction with other medical policies, for example durable medical equipment. Here, the main idea is that any outpatient therapy is now subject to a $2,010 threshold. DPMS. KX Modifier-Documentation on File Many policies require the KX modifier be added to the code to indicate specific required documentation is on file. 0000004527 00000 n Billing for DME When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier (s) to describe the items being billed. Medicare allows 36 sessions, with the option for an additional 36 sessions for each of these services. Certain DME equipment require CMN form from a doctor to support the medically necessity of the item to a beneficiary in order to reimburse the claim for DME supplier. Use of the KX modifier when there is no indication that the cap is … Currently, there is a threshold for using KX modifiers and a trigger for possible medical review. 0000031796 00000 n 0000037685 00000 n 10.3 - … and evidence of such is retained in the supplier’s files and available to the DME MAC upon request. 0000007165 00000 n The use of the KX modifier makes a bold statement, informing the carrier . The modifier that indicates what rental month you are billing does not match what we have on file. 0000040036 00000 n It is a signature on the order form (Proof of Delivery) along with the date from the beneficiary, which states beneficiary received the ordered item and also it determines the DME carrier to pay the amount to the DME supplier. Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) submitted to the DME Medicare Administrative Contractors; Gender-specific services for beneficiaries who are transgender, hermaphrodites or have ambiguous genitalia ; For speech language pathology, physical therapy or occupational therapy services: Submit this modifier when the patient has already met the … Is the therapy cap based on allowable charges or what I bill? Several DME categories and frequently used modifiers are listed below. Along with the RR modifier we used any one of the below modifier to identify the month of the rental item billed: If the item is purchased from the beneficiary, then below modifier are used: NU modifier is used to indicate Purchase of new equipment, UE modifier is used to indicate purchase of used equipment. Click Save. KX Modifier ◦ Requirements specified in the medical policy have been met ◦ Coverage criteria and documentation requirements must be met ◦ Documentation is essential in supporting the item is reasonable and necessary ◦ Review each specific LCD to confirm the documentation requirements and which codes require use of the KX 0000017661 00000 n 0000039419 00000 n 0000016896 00000 n 0000003163 00000 n 0000041054 00000 n 0000006094 00000 n 0000048456 00000 n 0000010268 00000 n The GA modifier is used ONLY when there is an ABN on file indicating that therapy is NOT medically necessary. 0000007902 00000 n 0000048026 00000 n 0000010767 00000 n Modifier Ordering. 0000049046 00000 n This modifier is used for capped rental DME items. 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 … %PDF-1.4 %���� 0000039684 00000 n Refer to the Durable Medical Equipment (DME) payment policy for more information. 0000002583 00000 n 0000040883 00000 n 0000040230 00000 n Below is an example of the KX modifier on a Medicare DME claim: The LCD's for oral appliances for OSA state: "Suppliers must add a KX modifier to a code only if all of the criteria in the "Indications and Limitations of Coverage and/or Medical Necessity" section of this policy have been met. KX Modifier Thresholds (formerly known as Therapy Cap Process) Under Medicare Part B, the annual limitations on per beneficiary incurred expenses for outpatient therapy services are commonly referred to as “therapy caps” now known as KX modifier thresholds. Let us see some of the important and frequently used modifier we come upon while billing DME in medical billing: KX modifier is used to indicate required documentation is on file to support the medical necessity of the item. 0000014035 00000 n (Refer to page 2 of the November 2014 HealthPro News edition for more information). Procedure is inconsistent with the modifier. Apply the KX modifier when you provide medically necessary services above the soft cap. 0000007346 00000 n 0000048699 00000 n Q. KX Modifier: HCPCS Codes Page 2 of 25 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 05/13/2020 Proprietary Information of UnitedHealthcare.  Enter in the “remarks” section of the claim the condition for the exception  Append modifier KX  to the HIPPS code reported on the revenue code 0023 line  The Medicare Administrative Contractors (MACs) may request documentation from the HHA to support its request for an exception to waive of the consequences of late filing of a RAP when … For claims paid by a carrier or A/B MAC, it is only appropriate to append the KX modifier to a service that reasonably may exceed the cap. 0000001836 00000 n 0000042113 00000 n Today, I’m doing the same for the KX modifier and modifier 59—in a question and answer format. For physical therapy and Occupational Therapy, I know MCR requires the KX modifier once the patient has hit the $2040 cap to continue treatment. 0000015615 00000 n 0000012418 00000 n 0000049124 00000 n This is termed the KX modifier threshold. The narrative description for the KX modifier is: Requirements specified in the medical policy have been met The primary use of the KX modifier is to enable the DME MAC to perform automated medical review of claims. Medicare charges also require that a Therapy Modifier (GP, GO, GN) be attached to each service code. DME FOR . 0000040309 00000 n The date of death is before the date of service. Appending the KX modifier is an attestation by the provider that documentation is on file verifying the patient has non-reversible symptomatic bradycardia. Therapists should continue to affix the KX modifier to all medically necessary services above the designated limit ($2,010 in 2018), thus signaling Medicare to pay the claim. 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