Showing posts with label KX modifier. Show all posts
Showing posts with label KX modifier. Show all posts

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.

Friday, July 15, 2016

Modifier KX for use with Therapy Services




Modifier KX is used to confirm requirements outlined in the appropriate Local Coverage Determination (LCD), are met for the procedure billed.

By adding modifier KX to a claim, you are stating that your claim has met specific documentation requirements in the policy, and would be available upon request from the Medicare Administrative Contractor (MAC).

Add this modifier to each procedure code once the specific therapy cap has been met.

Modifier KX should follow the appropriate therapy modifiers.

Documentation must support and justify that the beneficiary qualifies for the therapy cap exception and that services are reasonable and necessary and require the skills of a therapist
The KX may be submitted on physical therapy, occupational therapy or speech language pathology claims.
Appropriate Use:
When additional documentation supports the medical requirements of the service under a valid medical policy.
Inappropriate Use:
When the claim provides all information on the service billed and medical documentation does not provide further explanation.
Claim does not meet policy guidelines/ Indications and Limitations of Coverage and/or Medical Necessity.
The most frequent use of the KX modifier is in relation to therapy services.
Physical/Speech/Occupational Therapy
When the service qualifies for an automatic claims processing exception * based on the published list of excepted conditions and complexities, submit the service with Healthcare Common Procedure Coding System (HCPCS) modifier KX.
The KX must be added to each claim line identified as a therapy service when therapy cap exceptions meet all guidelines for an automatic exception and must follow the required therapy HCPCS modifiers GN (speech-language pathology), GO (occupational therapy) and GP (physical therapy). This allows payment for the approved therapy services, even though they are above the therapy cap financial limits.
The presence of the KX modifier demonstrates that services billed:
Qualify for the therapy cap exception
Are reasonable and necessary services that require the skills of a therapist,
Are justified by appropriate documentation in the medical record
Therapy services submitted without the KX modifier, for claims above the therapy threshold, will deny.
Exceptions to therapy caps based on the medical necessity of the service are in effect only when included in Congressional legislation.

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