License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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Updated 06.29.18

KX Table

Please be advised: The information listed in this chart may not include all of the coverage criteria for a given product/service. You may refer to the corresponding LCD for further coverage requirement information.

LCD Name	LCD ID Active/Current	Policy-Specific Meaning of KX *CILMN (Coverage Indications, Limitations and/or Medical Necessity)
AFO/KAFO	L33686	Coverage criteria in CILMN* met - Base and Additions
AED	L33690	Coverage criteria in CILMN* met
Cervical Traction Devices	L33823	Coverage criteria in CILMN* met - Specific to codes E0849 and E0855
Commodes	L33736	Coverage criteria in CILMN* met - Specific to codes E0163-E0171
External Infusion Pumps	L33794	C-peptide requirement in CILMN* met - And, insulin pump code E0784 is billed with insulin code J1817
Glucose Monitors	L33822	Insulin-treated beneficiary use KX. Non-insulin treated beneficiary use KS.
High Frequency Chest Wall Osciillation	L33785	Coverage criteria in CILMN* met
Home Dialysis Supplies & Equipment		Supplier has written agreement with a Medicare-certified service support facility
Hospital Beds	L33820	Coverage criteria in CILMN* met
Immunosuppressive Drugs	L33824	Supplier has all four requirements. The supplier has obtained from the ordering physician the specific date of the organ transplant, and The supplier is retaining this documentation of the transplant in its files, and The beneficiary was enrolled in Medicare Part A, at the time of the organ transplant (whether or not Medicare paid for the transplant), and The transplant date precedes the date of service on the claim.
Knee Orthoses	L33318	Coverage criteria in CILMN* met - Base and Additions
Manual Wheelchair Bases	L33788	Coverage criteria in CILMN* met - Base only
Nebulizers	L33370	Coverage criteria in CILMN* met - Specific to codes E0574, J7686, K0730 and Q4074
Negative Pressure Wound Therapy Pumps	L33821	Coverage criteria in CILMN* met
Oral Antiemetic Drugs	L33827	Use of J8540 and either J8501, or Q0181, or the three drug combination of Q0181, Q9978, or J8655 in conjunction with anticancer chemotherapeutic agents listed in CILMN*
Oral Appliances for Obstructive Sleep Apnea	L33611	Coverage criteria in CILMN* met
Orthopedic Footwear	L33641	Shoe that is an integral part of a leg brace or for related modifications, inserts, heel/sole replacements or shoe transfer
Oxygen and Oxygen Equipment	L33797	Coverage criteria in CILMN* met effective for dates of service on or after 8/1/2018
Patient Lifts	L33799	Coverage criteria in CILMN* met - Specific to codes E0636, E1035, and E1036
Positive Airway Pressure (PAP) Devices	L33718	Coverage criteria in CILMN* met - Base and Accessories
Power Mobility Devices	L33789	For base and accessories, KX means 1) All of the coverage criteria specified in CILMN* is met for the product provided; or 2) There is an affirmative ADMC decision for the product that is provided.
Pressure Reducing Support Services Group 1	L33830	Coverage criteria in CILMN* met
Pressure Reducing Support Services Group 2	L33642	Coverage criteria in CILMN* met
Pressure Reducing Support Services Group 3	L33692	Initial month's claim - coverage criteria in CILMN*met - Subsequent month's claims - only with physician certification that continued use is necessary.
Refractive Lenses	L33793	Physician documents medical necessity for codes V2750, V2744, V2745 or V2780. For code V2784, patient has monocular vision.
Respiratory Assist Devices	L33800	Coverage criteria in CILMN* met - Required adherence statement from treating physician for E0470, E0471 and accessory codes obtained and in supplier files
Speech Generating Devices	L33739	Coverage criteria in CILMN* met
Therapeutic Shoes for Persons with Diabetes	L33369	Add to shoes, inserts and/or modifications only if all 5 are met - 1) Beneficiary has diabetes; 2) Physician certifies qualifying condition; 3) Physician certifies under comprehensive plan of care and needs shoes/inserts; 4) Prior to selecting items, supplier must conduct and document an in-person evaluation; 5) At delivery, supplier must conduct an objective assessment of the fit of the items and document.
Transcutaneous Electrical Nerve Stimulators	L34802	Coverage criteria in CILMN* met -Specific to codes E0720, E0730, and E0731
Urological Supplies	L33803	Coverage criteria in CILMN* met – Statutory benefit criteria described in the NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES section of the related Policy Article are met
Walkers	L33791	Codes E0148 or E0149 if patient weight > 300 lbs.
Wheelchair Options & Accessories	L33792	Coverage criteria in either Manual Wheelchair Bases or Power Mobility Devices CILMN* have been met - AND Coverage criteria in CILMN* met
Wheelchair Seating	L33312	All seat and back cushions and positioning accessories, if the item is being used with a wheelchair that meets CILMN* specified in the Manual Wheelchair Bases or Power Mobility Devices LCD. Codes E2603, E2604, K0734, K0735 if either criterion (a), (b), or (c) is met - If there is a past history of or current pressure ulcer in the area of contact with the seating surface; or If there is absent or impaired sensation in the area of contact with the seating surface due to one of the diagnoses listed as a covered diagnosis; or If there is an inability to carry out a functional weight shift due to one of the diagnoses listed as a covered diagnosis. Codes E2605, E2606, E2613-E2616, E2620, E2621, E0956-E0957, E0960, if there is significant postural asymmetries due to one of the diagnoses listed as a covered diagnosis. Code E0955 if one of the coverage criteria in CILMN* met. Codes E2607, E2608, E2624, and E2625 if criterion (a) or (b) or (c) is met and criterion (d) is met: If there is a past history or current pressure ulcer in the area of contact with the seating surface; or If there is absent or impaired sensation in the area of contact with the seating surface due one of the diagnoses listed as a covered diagnosis for skin protection cushions; or If there is an inability to carry out a functional weight shift due one of the diagnoses listed as a covered diagnosis for skin protection cushions; and If the patient has significant postural asymmetries due to one of the diagnoses listed as a covered diagnosis for positioning cushions. Codes E2609, E2617 if criterion (a) is met, and criterion (b), or (c), or (d) is met - For E2609 or E2617, there is a comprehensive written evaluation by a licensed/certified medical professional, such as a PT or OT (who has no financial relationship with the supplier) which explains why a prefabricated seating system is not sufficient to meet the patient's seating and positioning needs; and For E2609, there is a past history of or current pressure ulcer in the area of contact with the seating surface; or For E2609, there is absent or impaired sensation in the area of contact with the seating surface or an inability to carry out a functional weight shift due to one of the diagnoses listed as a covered diagnosis for skin protection cushions; or For E2609 or E2617, the patient has significant postural asymmetries due to one of the diagnoses listed as a covered diagnosis for positioning cushions.

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