Monday, October 10, 2016

Billing Guide Modifer KX and JW

Modifier KX

The KX modifier is a multipurpose, informational modifier and can be used to identify services for transgender, ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses. Physicians and non-physician practitioners should use modifier KX with procedure codes that are gender specific in the particular cases of transgender, ambiguous genitalia, and hermaphrodite beneficiaries.


Note: The KX modifier may also be used in conjunction with other medical policies, for example durable medical equipment. Refer to the Durable Medical Equipment (DME) payment policy for more information.

Modifier JW

Effective for dates of service on or after April 1, 2015, providers must submit modifier JW to identify unused drug or biologicals from single use vials or single use packages for the last dose of the day for that drug or biological that is appropriately discarded.

Provider Type Modifiers

Tufts Health Plan requires provider organization-affiliated psychiatrists to append appropriate modifiers for services provided by a non-M.D. clinician in their office. The modifiers will affect compensation according to clinician type. Refer to the Modifier Table for a list of these modifiers. Codes 96101, 96102, 96103, 96118, 96119 and 96120 will be excluded from the modifier logic when billed with modifier AH and HP.

Note: Tufts Health Plan does not compensate for services provided by a non-independently licensed clinician providing services under the supervision of a provider organization–affiliated psychiatrist.

Therapy Modifiers

Effective for dates of service on or after October 1, 2015, Tufts Health Plan will not compensate for non-therapy services billed with modifiers GN, GO and GP.

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