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

2012-07 KX Modifier Billing Reminder





July 03, 2012

KX Modifier Billing Reminder
  • Supplier usage of the KX modifier identifies that the requirements identified in the medical policy have been met. Documentation is essential to support that the item is reasonable and necessary and that the specific coverage criteria specified in each policy have been met.
  • The KX modifier has differing requirements for usage depending on the specific Local Coverage Determination (LCD); suppliers should review the LCDs carefully to understand the documentation requirements and the proper use of the KX modifier for each policy.
  • Below is a list of LCDs which include a KX modifier requirement for some or all items within that specific LCD. Use of the KX modifier with any other DMEPOS is inappropriate usage.
    Ankle-Foot/Knee-Ankle-Foot Orthosis
    Automatic External Defibrillators
    Cervical Traction Devices
    External Infusion Pumps
    Glucose Monitors
    High Frequency Chest Wall Oscillation Devices
    Hospital Beds
    Immunosuppressive Drugs
    Knee Orthoses
    Manual Wheelchair Bases
    Negative Pressure Wound Therapy Devices
    Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
    Oral Appliances for Obstructive Sleep Apnea
    Orthopedic Footwear
    Patient Lifts
    Positive Airway Pressure Devices
    Power Mobility Devices
    Pressure Reducing Support Surfaces
    Refractive Lenses
    Respiratory Assist Devices
    Speech Generating Devices
    Therapeutic Shoes for Persons with Diabetes
    Transcutaneous Electrical Nerve Stimulators (TENS)
    Urological Supplies
    Wheelchair Options and Accessories
    Wheelchair Seating
  • It is important to remember, if the requirements specified in the LCD are not met the KX modifier must not be used.
    Most LCDs include a modifier which indicates the documentation requirements are not met by appending either a GA, GY, or GZ modifier if a claim is denied for missing one of these modifiers it must be resubmitted. Refer to the KX, GA, GZ and GY Modifiers – New Uses article for additional information.
    Be sure to review each LCD closely to determine which modifier is appropriate when the LCD documentation requirements are not met.