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. Appending the KX modifier is an attestation by the provider that documentation is on file verifying the patient has non-reversible symptomatic bradycardia. KX Modifier-Documentation on File Many policies require the KX modifier be added to the code to indicate specific required documentation is on file. Joint DME MAC Bulletin Article. If the item is rented from the beneficiary, then below modifier are used: RR modifier is used to indicate rental equipment. 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. Proper Use of the KX Modifier. Please contact Medicare and let them know of the billing mistake, this way it becomes a voluntary admission and is not used against you. Lifetime benefit maximum has been reached/ billing exceeds the rental months covered / Payment cannot be made after the reasonable purchase price has been met. 0000040152 00000 n Medicare allows 36 sessions, with the option for an additional 36 sessions for each of these services. 0000011166 00000 n 0000002583 00000 n 0000004527 00000 n 0000039340 00000 n 0000041054 00000 n 0000010268 00000 n Several DME categories and frequently used modifiers are listed below. 0000040574 00000 n Is the therapy cap based on allowable charges or what I bill? DME requires a prescription to either rent or purchase the equipment. 0000040230 00000 n 0000005152 00000 n If the requirements for the KX modifier are not met, the KX modifier must not be used. 0000040425 00000 n 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. Both modifiers cannot be used on the same claim lines. 0000025168 00000 n 0000034942 00000 n 0000048381 00000 n 0000014887 00000 n 149 0 obj <> endobj xref 149 77 0000000016 00000 n Modifier KX (Documentation on file) to indicate whether the patient is insulin dependent. 0000039265 00000 n 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 _�. 0000038774 00000 n Continued on page 52 E1038 HCPCS Code Dates, Status, Action: Status: ACTUAL: Possible status values: Actual Actual HCPCS Code; Discontinued Discontinued HCPCS … 0000048026 00000 n 0000012418 00000 n 0000039187 00000 n Chapter 16 of the Jurisdiction D DME Supplier Manual provides HCPCS codes with descriptions and the payment categories. 0000039684 00000 n RB – Replacement of a part of DME as part of a repair . 0000002241 00000 n DPMS. Denials with solutions in Medical Billing, Denials Management – Causes of denials and solution in medical billing, CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a required modifier is missing, CO 5 Denial Code – The Procedure code/Bill Type is inconsistent with the Place of Service, CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, CO 7 Denial Code – The Procedure/revenue code is inconsistent with the patient’s gender, CO 15 Denial Code – The authorization number is missing, invalid, or does not apply to the billed services or provider, CO 17 Denial Code – Requested information was not provided or was insufficient/incomplete, CO 19 Denial Code – This is a work-related injury/illness and thus the liability of the Worker’s Compensation Carrier, CO 23 Denial Code – The impact of prior payer(s) adjudication including payments and/or adjustments, CO 31 Denial Code- Patient cannot be identified as our insured, CO 119 Denial Code – Benefit maximum for this time period or occurrence has been reached or exhausted, ICD 10 Code for Sepsis Severe Sepsis and Septic shock with examples, Molina Healthcare Phone Number claims address of Medicare and Medicaid, Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit, Kaiser Permanente Phone Number – Claims address and Timely Filing Limit, Amerihealth Caritas Phone Number, Payer ID and Claim address, Anthem Blue Cross Blue Shield Timely filing limit – BCBS TFL List, Workers Compensation Insurances List of United States, Workers Compensation time limit for filing Claim and reporting in United States, Amerihealth Caritas Directory – Healthcare, Health Insurance in United States of America, Place of Service Codes List – Medical Billing. 0000014409 00000 n Also it should have beneficiary name with complete address. The date of death is before the date of service. 0000016439 00000 n 0000048104 00000 n (Refer to page 2 of the November 2014 HealthPro News edition for more information). Modifier Ordering. 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. To bill additional optional sessions of cardiac rehab or pulmonary rehab. In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. 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 … Along with this KX modifier threshold, the new law retains the targeted medical review process but at a lower threshold amount of $3,000. It means DME is principally used to help in for a medical purpose, can endure for repeated use and suitable to use in the home. I tried to look on the UHC site and also googled a lot of things, but the only thing I … Correct Use of the KX Modifier During the COVID-19 PHE. 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. The service delivered beyond that require a KX modifier that indicates that the service meets the criteria for payment exception. Refer to the Durable Medical Equipment (DME) payment policy for more information. 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. The therapy cap is based on allowable charges, according to your region’s Medicare allowable fee schedule. This modifier is used for capped rental DME items. 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. KX Modifier – Documentation on File . 0000015222 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. Documentation is essential to support that the item is reasonable and necessary and that … 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. Modifier KX is used to confirm requirements outlined in the appropriate Local Coverage Determination (LCD), are met for the procedure billed. 0000044925 00000 n 0000006094 00000 n 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. This includes: Therapy Cap-Related Modifier: KX. The KX modifier will get paid because it is an automated edit. Supplier usage of the KX modifier identifies that the requirements identified in the medical policy have been met. 0000042113 00000 n The GA modifier is used ONLY when there is an ABN on file indicating that therapy is NOT medically necessary. The KX modifier thresholds are determined on a calendar year basis, which means that all beneficiaries begin a new … 0000048268 00000 n (EFFECTIVE DATE 1/1/2003) 0000006206 00000 n Note: The KX modifier may also be used in conjunction with other medical policies, for example durable medical equipment. KX Modifier: HCPCS Codes Page 2 of 25 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 05/13/2020 Proprietary Information of UnitedHealthcare. 0000040036 00000 n Claims lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information. Or what I bill that can be submitted with electronic claims is limited used whenever maximum units... 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