LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2011-06 Claims Modifiers for Use in DMEPOS Competitive Bidding Program

Claims Modifiers for Use in the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program

MLN Matters Number: SE1035 Revised
Related Change Request (CR) #: N/A
Related CR Release Date: N/A
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A
Note: This article was revised on June 21, 2011 to provide a new Web address on page 5 for the single payment amounts. All other information remains unchanged.

  • Provider Types Affected
    All Medicare Fee-For-Service (FFS) providers and suppliers who provide Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) to Medicare beneficiaries with Original Medicare who reside in or travel to a Competitive Bidding Area (CBA), including: contract and non-contract suppliers; physicians and other treating practitioners providing walkers to their own patients; hospitals providing walkers to their own patients; and Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs) that provide enteral nutrition to residents with a permanent residence in a CBA.
  • Background
    Under the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, beneficiaries with Original Medicare who obtain competitive bidding items in designated CBAs are required to obtain these items from a contract supplier, unless an exception applies. The first phase of the program begins on January 1, 2011, in nine CBAs for nine product categories.
    In order for Medicare to make payment, where appropriate, for claims subject to competitive bidding, it is important that all providers and suppliers who provide DMEPOS affected by the program use the appropriate modifiers on each claim. Note: To ensure accurate claims processing, it is critically important for suppliers to submit each claim using the billing number/ National Provider Identifier (NPI) of the location that furnished the item or service being billed.
  • Competitive Bidding Modifiers
    New Healthcare Common Procedure Coding System (HCPCS) modifiers have been developed to facilitate implementation of various policies that apply to certain competitive bidding items. The new HCPCS modifiers used in conjunction with claims for items subject to competitive bidding are defined as follows:
    J4: MEPOS Item Subject to DMEPOS Competitive Bidding Program that is Furnished by a Hospital Upon Discharge.
    KG: DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 1.
    KK: DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 2.
    KU: DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 3.
    KW: DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 4.
    KY-DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 5.
    KL-DMEPOS Item Delivered via Mail.
    KV-DMEPOS Item Subject to DMEPOS Competitive Bidding Program that is Furnished as Part of a Professional Service.
    KT-Beneficiary Resides in a Competitive Bidding Area and Travels Outside that Competitive Bidding Area and Receives a Competitive Bid Item.
  • Competitive Bid Item
    Suppliers should submit claims for competitive bidding items using the appropriate HCPCS code and corresponding competitive bidding modifier in effect during a contract period. The competitive bidding modifiers should be used with the specific, appropriate competitive bidding HCPCS code when one is available. The modifiers associated with particular competitive bid codes, such as the KG, KK, or KL HCPCS modifiers, are listed by competitive bid product category on the single payment amount public use charts found under the supplier page at on the Competitive Bidding Implementation Contractor (CBIC) website.
    Failure to use or inappropriate use of a competitive bidding modifier on a competitive bidding claim leads to claims denial. The use of a competitive bidding modifier does not supersede existing Medicare modifier use requirements for a particular code, but rather should be used in addition, as required. Another HCPCS modifier was developed to facilitate implementation of DMEPOS fee schedule policies that apply to certain competitive bidding items that were bid prior to July 1, 2008, under the initial Round I of the DMEPOS Competitive Bidding Program. The KE HCPCS modifier is defined as follows:
    KE-DMEPOS Item Subject to DMEPOS Competitive Bidding Program for use with Non-Competitive Bid Base Equipment.
  • How to Use the Modifiers
    Hospitals Providing Walkers and Related Accessories to Their Patients on the Date of Discharge: J4 HCPCS Modifier Hospitals may furnish walkers and related accessories to their own patients for use in the home during an admission or on the date of discharge and receive payment at the applicable single payment amount, regardless of whether the hospital is a contract supplier or not. Please note that separate payment is not made for walkers furnished by a hospital for use in the hospital, as payment for these items is included in the Part A payment for inpatient hospital services.
    To be paid for walkers as a non-contract supplier, the hospital must use the HCPCS modifier J4 in combination with the following HCPCS codes: A4636; A4637; E0130; E0135; E0140; E0141; E0143; E0144; E0147; E0148; E0149; E0154; E0155; E0156; E0157; E0158 and E0159. Under this exception, hospitals are advised to submit the claim for the hospital stay before or on the same day as they submit the claim for the walker to ensure timely and accurate claims processing. Hospitals that are located outside a CBA that furnish walkers and/or related accessories to travelling beneficiaries who live in a CBA must affix the J4 HCPCS modifier, to claims submitted for these items.
    The J4 HCPCS modifier should not be used by contract suppliers.
  • Modifiers for HCPCS Accessory or Supply Codes Furnished in Multiple Product Categories: KG, KK, KU, KW, and KY HCPCS Modifiers
    The KG, KK, KU, KW, and KY HCPCS modifiers are modifiers that identify when the same supply or accessory HCPCS code is furnished in multiple competitive bidding product categories or when the same code can be used to describe both competitively and non-competitively bid items. For example, HCPCS code E0981 Wheelchair Accessory, Seat Upholstery, Replacement Only, Each is found in both the standard and complex rehabilitative power wheelchair competitive bidding product categories. Contract suppliers for the standard power wheelchair product category as well as other suppliers submitting claims for this accessory item furnished for use with a standard power wheelchair shall submit HCPCS code E0981 claims using the KG HCPCS modifier.
    Contract suppliers for the complex rehabilitative power wheelchair product category as well as other suppliers submitting claims for this accessory item furnished for use with a complex power wheelchair shall submit claims for HCPCS code E0981 using the KK HCPCS modifier. Another example of the use of the KG HCPCS modifier is with HCPCS code A4636 Replacement, Handgrip, Cane, Crutch, or Walker, Each. Contract suppliers for the walkers and related accessories product category in addition to other suppliers submitting claims for this accessory item when used with a walker shall submit HCPCS code A4636 claims using the KG HCPCS modifier.
    All suppliers that submit claims for beneficiaries that live in a CBA, including contract, non-contract, and grandfathered suppliers, should submit claims for competitive bid items using the above mentioned competitive bidding modifiers. Non-contract suppliers that furnish competitively bid supply or accessory items to traveling beneficiaries who live in a CBA must use the appropriate KG or KK HCPCS modifier with the supply or accessory HCPCS code when submitting their claim. Also, grandfathered suppliers that furnish competitively bid accessories or supplies used in conjunction with a grandfathered item must include the appropriate KG or KK HCPCS modifier when submitting claims for accessory or supply codes. The KG and KK HCPCS modifiers are used in the Round I Rebid of the competitive bidding program as pricing modifiers and the KU, KW and KY HCPCS modifiers are reserved for future program use.
    The competitive bidding HCPCS codes and their corresponding competitive bidding HCPCS modifiers (i.e. KG, KK, KL) are denoted in the single payment amount “public use charts found under the supplier page at”:
    http://www.dmecompetitivebid.com/Palmetto/Cbic.nsf on the CBIC website.
  • Purchased Accessories & Supplies for Use with Grandfathered Equipment: HCPCS KY Modifier
    Non-contract grandfathered suppliers must use the KY HCPCS modifier on claims for CBA-residing beneficiaries with dates of service on or after January 1, 2011, for purchased, covered accessories or supplies furnished for use with rented grandfathered equipment.
    The following HCPCS codes are the codes for which use of the KY HCPCS modifier is authorized:
    Continuous Positive Airway Pressure Devices, Respiratory Assistive Devices, and Related Supplies and Accessories – A4604, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, and E0562;
    Hospital Beds and Related Accessories – E0271, E0272, E0280, and E0310; and
    Walkers and Related Accessories – E0154, E0156, E0157 and E0158
    Until notified otherwise, grandfathered suppliers that submit claims for the payment of the aforementioned purchased accessories and supplies for use with grandfathered equipment should submit the applicable single payment amount for the accessory or supply as their submitted charge on the claim. The single payment amounts for items included in the Round 1 Rebid of the DMEPOS Competitive Bidding Program can be found under the Single Payment Amount tab on the following website (LINK NOW BROKEN) .
    Non-contract grandfathered suppliers should be aware that purchase claims submitted for these codes without the KY HCPCS modifier will be denied. Also, claims submitted with the KY HCPCS modifier for HCPCS codes other than those listed above will be denied.
    After the rental payment cap for the grandfathered equipment is reached, the beneficiary must obtain replacement supplies and accessories from a contract supplier. The supplier of the grandfathered equipment is no longer permitted to furnish the supplies and accessories once the rental payment cap is reached.
  • Mail Order Diabetic Supplies: KL HCPCS Modifier
    Contract suppliers must use the KL HCPCS modifier on all claims for diabetic supply codes that are furnished via mail order. Non contract suppliers that furnish mail order diabetic supplies to beneficiaries who do not live in CBAs must also continue to use the KL HCPCS modifier with these codes. Suppliers that furnish mail-order diabetic supplies that fail to use the HCPCS modifier KL on the claim may be subject to significant penalties. For claims with dates of service prior to implementation of a national mail order competitive bidding program, the KL HCPCS modifier is not used with diabetic supply codes that are not delivered to the beneficiary’s residence via mail order or are obtained from a local supplier storefront. Once a national mail order competitive bidding program is implemented, the definition for mail order item will change to include all diabetic supply codes delivered to the beneficiary via any means. At this time, the KL HCPCS modifier will need to be used for all diabetic supply codes except for claims for items that a beneficiary or caregiver picks up in person from a local pharmacy or supplier storefront.
  • Physicians and Treating Practitioners Who Furnish Walkers and Related Accessories to Their Own Patients but Who Are Not Contract Suppliers: KV HCPCS Modifier
    The KV HCPCS modifier is to be used by physicians and treating practitioners who are not contract suppliers and who furnish walkers and related accessories to beneficiaries in a CBA. Walkers that are appropriately furnished in accordance with this exception will be paid at the single payment amount.
    To be paid for walkers as a non-contract supplier, physicians and treating practitioners should use the KV HCPCS modifier in combination with the following HCPCS codes: A4636; A4637; E0130; E0135; E0140; E0141; E0143; E0144; E0147; E0148; E0149; E0154; E0155; E0156; E0157; E0158; and E0159. On the claim billed to the Durable Medical Equipment Medicare Administrative Contractor (DME MAC), the walker line item must have the same date of service as the professional service office visit billed to the Part A/Part B MAC. Physicians and treating practitioners are advised to submit the office visit claim and the walker claim on the same day to ensure timely and accurate claims processing.
    Physicians and treating practitioners who are located outside a CBA who furnish walkers and/or related accessories as part of a professional service to traveling beneficiaries who live in a CBA must affix the KV HCPCS modifier to claims submitted for these items. The KV HCPCS modifier should not be used by contract suppliers.
  • Traveling Beneficiaries: KT HCPCS Modifier
    Suppliers must submit claims with the KT HCPCS modifier for non-mail-order DMEPOS competitive bidding items that are furnished to beneficiaries who have traveled outside of the CBA in which they reside. If a beneficiary who lives in a CBA travels to an area that is not a CBA and obtains an item included in the competitive bidding program, the non contract supplier must affix this modifier to the claim. Similarly, if a beneficiary who lives in a CBA travels to a different CBA and obtains an item included in the competitive bidding program from a contract supplier for that CBA, the contract supplier must use the KT HCPCS modifier.
    SNFs and NFs that are not contract suppliers and are not located in a CBA must also use the KT HCPCS modifier on claims for enteral nutrition items furnished to residents with a permanent home address in a CBA. SNF or NF claims that meet these criteria and are submitted without the KT HCPCS modifier will be denied.
    Claims for mail-order competitive bidding diabetic supplies submitted with the KT HCPCS modifier will be denied. Contract suppliers must submit mail-order diabetic supply claims for traveling beneficiaries using the beneficiary’s permanent home address.
    To determine if a beneficiary permanently resides in a CBA, a supplier should follow these two simple steps:
    Ask the beneficiary for the ZIP code of his or her permanent residence. This is the address on file with the Social Security Administration (SSA).
    Enter the beneficiary’s ZIP code into the CBA finder tool on the home page of the Competitive Bidding Implementation Contractor (CBIC) website, found at www.dmecompetitivebid.com on the Internet.
  • The KE Modifier
    Section 154(a)(2) of the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 mandated a fee schedule covered item update of -9.5% for 2009 for items included in the Round I of the DMEPOS Competitive Bidding Program. This covered item update reduction to the fee schedule file applies to items furnished on or after January 1, 2009, in any geographical area.
    In order to implement the covered item update required by MIPPA, the KE HCPCS modifier was added to the DMEPOS fee schedule file in 2009 to identify Round I competitively bid accessory codes that could be used with both competitively bid and non-competitively bid base equipment. All suppliers must use the KE HCPCS modifier on all Part B Fee-For-Service claims to identify when a Round I bid accessory item is used with a non-competitively bid base item (an item that was not competitively bid prior to July 2008).
    For example, HCPCS code E0950 Wheelchair Accessory, Tray, Each can be used with both Round I competitively bid standard and complex rehabilitative power wheelchairs (HCPCS codes K0813 thru K0829 and K0835 thru K0864), as well as with non-competitively bid manual wheelchairs (HCPCS codes K0001 thru K0009) or a miscellaneous power wheelchair (HCPCS code K0898). All suppliers must use the KE HCPCS modifier with the accessory code to identify when HCPCS code E0950 is used in conjunction with a non-competitively bid manual wheelchair (HCPCS code K0001 thru K0009) or a miscellaneous power wheelchair (HCPCS code K0898). The KE HCPCS modifier should not be used with competitive bid accessory HCPCS codes that are used with any competitive bid base item that was included in the initial Round I of the Competitive Bidding Program prior to July 1, 2008. Therefore, in the above example, KE is not valid for use with accessory HCPCS code E0950 when used with standard power wheelchairs, complex rehabilitative power wheelchairs (Group 2 or Group 3), or any other item selected for competitive bidding prior to July 1, 2008.
    For beneficiaries living in competitive bid areas on or after January 1, 2011, suppliers should not use the KE HCPCS modifier to identify competitively bid accessories used with base equipment that was competitively bid under the Round I Rebid Competitive Bidding Program. Rather, such claims should be submitted using the appropriate KG or KK HCPCS modifiers as identified on the single payment amount public use charts found under the supplier page at www.dmecompetitivebid.com/Palmetto/Cbic.nsf on the CBIC website.
  • The chart below illustrates the relationship between the competitive bid HCPCS modifiers (KG, KK, KU, KW, and KY) and the KE HCPCS modifier using competitively bid accessory HCPCS code E0950: Accessory HCPCS Code E0950 Used With Base Code Competitive Bid Status Claim for a Beneficiary who Permanently Lives in a CBA Claim for a Beneficiary who Permanently Lives Outside a CBA*
    1. Manual Wheelchair (K0001 thru K0009) or Miscellaneous Power Wheelchair (K0898) Non- Bid Bill with KE HCPCS modifier Bill with KE HCPCS modifier
  1. Standard Power Wheelchair (HCPCS codes K0813 thru K0829) Bid in Round 1 and the Round 1 Rebid Bill with KG HCPCS modifier Bill without KE HCPCS modifier
  1. Complex Rehabilitative Group 2 Power Wheelchair (HCPCS codes K0835 thru K0843) Bid in Round 1 and the Round 1 Rebid Bill with KK HCPCS modifier Bill without KE HCPCS modifier
  1. Complex Rehabilitative Group 3 Power Wheelchair (HCPCS codes K0848 thru K0864) Bid in Round 1 Bill without KE, KK or KG HCPCS modifier Bill without KE HCPCS modifier
  • The competitive bid HCPCS modifiers (KG, KK, KU, KW, and KY) are only used on claims for beneficiaries that live in a Competitive Bidding Area (CBA).
  • Additional Information
    The Medicare Learning Network® (MLN) has prepared several fact sheets with information for non-contract suppliers and referral agents, including fact sheets on the hospital and physician exceptions, enteral nutrition, mail order diabetic supplies, and traveling beneficiaries, as well as general fact sheets for non-contract suppliers and referral agents. They are all available, free of charge, at.
  • Disclaimer
    This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.