Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare … Use of the KX Modifier for Therapy Cap Exceptions. It means Medicare insurance as secondary they pay just for the purchased items. Supplier usage of the KX modifier identifies that the requirements identified in the medical policy have been met. • Vision … Durable Medical … 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. 0000016896 00000 n When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier(s) to describe the items being billed.Also include an ICD-9/ICD-10 diagnosis code indicating the medical condition for which the item has been prescribed. 0000041807 00000 n The most DME denials in Medical billing are as follows: What is Medical Billing and Medical Billing process steps in USA? 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 Medicare charges also require that a Therapy Modifier (GP, GO, GN) be attached to each service code. h�b```c`�hb`g`p�cd@ AV�(G�ʭ �pN�{�\&Npp�e���2X��[���f㴴� �bl��v�g'��'��E��d����?30>a��z3�eLb�cbeVb��t��c�^���|L_��t5��1]��^���G�kc)�8�c�L _�. The KX modifier will get paid because it is an automated edit. and evidence of such is retained in the supplier’s files and available to the DME MAC upon request. DME requires a prescription to either rent or purchase the equipment. When using the KI modifier, you are indicating you are billing for the second and/or third month of the capped rental period A8 — DRESSING FOR EIGHT WOUNDS. Note: The KX modifier may also be used in conjunction with other medical policies, for example durable medical equipment. The GA modifier is used ONLY when there is an ABN on file indicating that therapy is NOT medically necessary. 0000017661 00000 n For physical therapy and Occupational Therapy, I know MCR requires the KX modifier once the patient has hit the $2040 cap to continue treatment. %PDF-1.4 %���� Q. If the item is rented from the beneficiary, then below modifier are used: RR modifier is used to indicate rental equipment. 0000025168 00000 n Therapy Cap-Related Modifier: KX. A. 0000010268 00000 n 0000038097 00000 n For samples of Durable Medical Equipment is: Wheelchair, Walker, Hospital beds, CPAP devices, Oxygen equipment, Nebulizers, Blood testing strips, Commode Chairs, Crutches, Medical supplies and so on. 0000041530 00000 n 0000040036 00000 n If the item is rented from the beneficiary, then below modifier are used: RR modifier is used to indicate rental equipment. 0000039535 00000 n Both modifiers cannot be used on the same claim lines. Therapy Cap …. 0000014887 00000 n 0000048456 00000 n 0000006206 00000 n 0000002418 00000 n Claims lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information. This service isn’t covered since our records show that the beneficiary was in the hospital/SNF on the date of service billed. • Dental. I tried to look on the UHC site and also googled a lot of things, but the only thing I … 0000040309 00000 n If the requirements for the KX modifier are not met, the KX modifier must not be used. 0000006094 00000 n Procedure is inconsistent with the modifier.  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 … The use of the KX modifier makes a bold statement, informing the carrier . 0000048699 00000 n Today, I’m doing the same for the KX modifier and modifier 59—in a question and answer format. 0000014409 00000 n Please make sure your billing staffs are aware of these updates. 0000016439 00000 n Medical equipment’s that are utilized by the provider in treatment of the procedure or it’s prescribed by the provider to the patient, which is appropriate to use in the home and helps to boost patient’s daily activities. LT – Left side. 0000009505 00000 n 0000015222 00000 n The therapy cap was permanently eliminated 1/1/2018,however the KX modifier must be used at the threshold amount of $2040 to indicate that therapy is medically necessary. The KX modifier thresholds are determined on a calendar year basis, which means that all beneficiaries begin a new … Modifier KX is used to confirm requirements outlined in the appropriate Local Coverage Determination (LCD), are met for the procedure billed. 0000014803 00000 n Information relating to coverage criteria that can be submitted with electronic claims is limited. 0000005152 00000 n Several DME categories and frequently used modifiers are listed below. 0000040938 00000 n 0000048553 00000 n 0000014035 00000 n Modifier Ordering. 0000011650 00000 n Durable Medical Equipment Modifiers for DME Services. For CY 2021, the KX modifier threshold amounts are: a) $2,110 for Physical Therapy (PT) and Speech-Language Pathology (SLP) services combined, and b) $2,110 for Occupational Therapy (OT) services. Appending the KX modifier is an attestation by the provider that documentation is on file verifying the patient has non-reversible symptomatic bradycardia. If all of the criteria in the Indications and Limitations of Coverage and /or Medical Necessity section have not been met, the GA or GZ modifier must be added to the code. RB – Replacement of a part of DME as part of a repair . 0000040883 00000 n The date of death is before the date of service. 0000047987 00000 n 0000037685 00000 n Does anyone know if this only applies to Novitas MCR or does it apply all MCR plans, for example UHC Medicare Advantage, AARP Complete or Aetna Medicare? This includes: KX Modifier-Documentation on File Many policies require the KX modifier be added to the code to indicate specific required documentation is on file. Currently, there is a threshold for using KX modifiers and a trigger for possible medical review. CAPPED RENTAL DME (PRICE SUBJECT TO FLOORS AND CEILINGS). For those LCD s 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) 0000007902 00000 n Q. Refer to the Durable Medical Equipment (DME) payment policy for more information. 0000040425 00000 n Authorization is required from insurances for a few of the Durable Medical Equipment’s and it varies from insurance to insurance. 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