Currently, there is a threshold for using KX modifiers and a trigger for possible medical review. Q. KX – The KX modifier should be added to the code to indicate that specific required documentation is on file to support the medical necessity of the item. 0000048026 00000 n RB – Replacement of a part of DME as part of a repair . (HCPCS) Codes … June 2011 Provider Bulletin – Colorado NOCIRC. I tried to look on the UHC site and also googled a lot of things, but the only thing I … 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. Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare … Use of the KX Modifier for Therapy Cap Exceptions. Durable Medical Equipment Modifiers for DME Services. If the item is rented from the beneficiary, then below modifier are used: RR modifier is used to indicate rental equipment. 10.3 - … 0000014035 00000 n 0000001836 00000 n 0000005152 00000 n Along with this KX modifier threshold, the new law retains the targeted medical review process but at a lower threshold amount of $3,000. 0000003902 00000 n 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. Appending the KX modifier is an attestation by the provider that documentation is on file verifying the patient has non-reversible symptomatic bradycardia. 0000007165 00000 n DME requires a prescription to either rent or purchase the equipment. 0000031796 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? 0000012418 00000 n  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 … 0000002583 00000 n Joint DME MAC Bulletin Article. The use of the KX modifier makes a bold statement, informing the carrier . 0000040883 00000 n 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 … 0000048699 00000 n Medicare charges also require that a Therapy Modifier (GP, GO, GN) be attached to each service code. 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. 0000038097 00000 n KX Modifier: HCPCS Codes Page 2 of 25 UnitedHealthcare Medicare Advantage Policy Appendix: Applicable Code List Approval 05/13/2020 Proprietary Information of UnitedHealthcare. Here, the main idea is that any outpatient therapy is now subject to a $2,010 threshold. The KX modifier will get paid because it is an automated edit. Please contact Medicare and let them know of the billing mistake, this way it becomes a voluntary admission and is not used against you. 0000007902 00000 n Use of the KX modifier when there is no indication that the cap is … Jun 30, 2011 … Emergency and Non-Emergent Medical Transportation. Refer to the Durable Medical Equipment (DME) payment policy for more information. If the requirements for the KX modifier are not met, the KX modifier must not be used. 0000041530 00000 n 0000007346 00000 n If you need to rebill the charge, check the Rebill box. The date of death is before the date of service. 0000042113 00000 n 0000038415 00000 n This is termed the KX modifier threshold. Also it should have beneficiary name with complete address. For more information about the medical review (MR) threshold see the below section 10.3.4. This includes: 0000044541 00000 n 0000034942 00000 n 0000015222 00000 n Therapy Cap …. Information relating to coverage criteria that can be submitted with electronic claims is limited. A. The only time Medicare covers Orthotics is if the patient has a form of amputation and that is an L5000 code. Proper Use of the KX Modifier. 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. Claims lines billed with codes without a KX, GA or GZ modifier will be rejected as missing information. E1038 HCPCS Code Dates, Status, Action: Status: ACTUAL: Possible status values: Actual Actual HCPCS Code; Discontinued Discontinued HCPCS … 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. 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. • Dental. 0000039419 00000 n Therapy Cap-Related Modifier: KX. 0000039684 00000 n 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 DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, SUPPLIES AND SURGICAL DRESSINGS: Description of Pricing Indicator Code #1 PLACE YOUR AD HERE. 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