Friday, May 20, 2022

KX modifier

doer human

*Someone on the list had a question about KX modifiers not so long ago.*
*So, just in case:*

KX Modifier Required on AFO/KAFO Claims
AOPA has received an unusually high number of inquiries regarding Medicare
denials of claims for AFOs and KAFOs. As a reminder, the Medicare Local
Coverage Determination (LCD) for Medicare AFOs and KAFOs was revised
effective June 1, 2009 to require the inclusion of the KX modifier when
medical necessity criteria have been met. Without the inclusion of a KX
modifier, the DME MACs will assume medical criteria have not been met and
automatically deny the claim as not medically necessary.

It is important to note that by including the KX modifier, you are attesting
that the criteria have been met and that appropriate documentation to
support medical necessity is in your files. If this is not the case, you
should not include the KX and you should expect the claim to be denied as
not medically necessary. In these instances, you can ask the patient to
accept financial liability by signing an Advanced Beneficiary Notice (ABN).
As with any ABN, you must indicate the specific reason why you believe
Medicare will deem the service not medically necessary.

Several of the DME MACs have recently indicated that claims that are denied
due to a missing KX modifier must be resubmitted correctly rather than using
the reopening process to include the KX modifier.

Questions? Contact Joe McTernan at
[email protected]or
(571) 431-0811.

*I. Lesko, LPO*


Experience is not what happens to you; it is what you do with what happens
to you. – Aldous Huxley

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