What does the KX modifier mean?

What does the KX modifier mean?

medically necessary
The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.

Where do you put the KX modifier?

The KX modifier is appended on claims at or very close to the $1920 cap, and should not applied from the first visit, even if the therapist knows that the cap will likely be exceeded.

Is KX modifier still valid?

Suppliers and providers can continue to use the KX modifier to request an exception to the therapy cap on claims that are over the annual cap amounts. There is no manual process for requesting exceptions. This allows the approved therapy services to be paid, even though they are above the therapy cap financial limits.

What is the KX modifier threshold for 2020?

For CY 2020, the KX modifier threshold amounts are: (a) $2,080 for PT and SLP services combined, and (b) $2,080 for OT services. remains at $3,000 until CY 2028 at which time it will be updated by the MEI.

Is there a Medicare cap?

In general, there’s no upper dollar limit on Medicare benefits. As long as you’re using medical services that Medicare covers—and provided that they’re medically necessary—you can continue to use as many as you need, regardless of how much they cost, in any given year or over the rest of your lifetime.

What is the 55 modifier?

postoperative management
Modifier 55 When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.

What does the KX modifier mean in medical policy?

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.

What does it mean to add KX to a claim?

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).

What does Kx mean on a DMEPOS Bill?

Modifier KX. Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item.

What does the KX mean on oral appliances?

Oral Appliances for Obstructive Sleep Apnea. The KX modifier indicates that all medical policy and documentation requirements have been met and that the billed item is reasonable and necessary. Review the specific LCD and policy article to determine the medical policy and documentation requirements.

What is modifier kX for?

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

What is Kx modifier examples?

For example, use of the KX modifier for low cost services early in an episode when there is no evidence of a previous episode that might have exceeded the cap is inappropriate. If there is a requirement in a specific policy to use a KX modifier to indicate that an item meets coverage criteria, then it is used in addition to the GK or GL modifier.

What is the KX modifier?

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.

What is Medicare modifier?

For Medicare purposes, modifiers are two-digit codes that may consist of alpha and/or numeric characters, which may be appended to procedure codes and/or HCPCS codes, to provide additional information needed to process a claim. This includes both HCPCS Level 1 (CPT) and HCPCS Level II codes.