July 27, 2020 - Revised: 12.17.20
Coronavirus Aid, Relief, and Economic Security Act (CARES Act) Adjustments and Modifier Usage
With the extension of payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) the supplier community is seeking clarification on the impacts to the usage of claim modifiers.
MLN Matters article MM11784 informs suppliers that Section 3712(b) of the CARES Act increases the non-rural fee schedule amounts for HCPCS codes for DMEPOS items that are adjusted based on payments determined under the DMEPOS Competitive Bidding Program (CBP). Medicare will use these schedules to pay for these items provided on or after March 6, 2020 through the end of the COVID-19 Public Health Emergency (PHE). The KE modifier (non-rural fee schedules for items bid in the initial Round 1 CBP) has been added back to the fee schedule file for the length of the PHE. See Attachments A and B of CR 11784
for a list of HCPCS codes and modifiers impacted by these changes.
No immediate action is needed for suppliers to receive the increased fee schedule amounts. For dates of service from March 6, 2020 through April 22, 2020, the DME MACs will automatically reprocessed affected claims to pay the higher blended 75/25 non-rural fees if the following is true:
- The FROM date of service is between March 6, 2020, through April 22, 2020
- The HCPCS/Modifier combination is on the list in Attachment A of CR 11784
- The claim line was previously paid
The automated adjustments are completed. The DME MACs will now accept requests to adjust claims for the KE modifier with dates of service beginning March 6, 2020 through April 22, 2020, when brought to the attention of the DME MACs by suppliers for HCPCS/Modifier combinations in Attachment B of CR 11784. Suppliers must notify the DME MACs to add the KE modifier by requesting claim reopenings/adjustments. The DME MACs will notify suppliers via listserv once the automated adjustments are completed.
CARES ACT Modifier Questions and Answers (Q&A):
Q: Starting back in 2018, the KE modifier was used for a list of specific option codes on manual wheelchairs (K0001 through K0009) for beneficiaries that live in a rural zip code. Should current claims continue to be billed with the KE modifier in these situations?
A: Yes.
Q: Does usage of the KE modifier associated with the CARES Act (MLN Matters MM11784), effective 3/6/20, for specific options codes with manual wheelchairs in non-rural zip codes and non-contiguous states apply to former CBAs?
A: No.
MLN Matters MM11784 – Extension of Payment for Section 3712 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) served two main purposes. Instructing the DME MACs to reprocess claims based on the new fee schedule and to demonstrate that CMS re-instated the use of the KE modifier for the non-rural fee areas.
Q: Does the language in the CARES Act regarding the usage of the KE modifier apply to HCPCS K0007?
A: Yes
Q: When will the automated CARES Act adjustments (MM11784) be completed?
A: The automated adjustments will begin once all associated claims have been identified and system logic has been tested.
Suppliers will be notified via listserv once the automated adjustments have been completed.
Q: Can the KU and KE be billed together on complex rehab and certain manual wheelchair accessories?
A: No. The KU and KE modifiers must not be billed together. The KU modifier should be billed on certain manual wheelchair accessories to receive the unadjusted fee amount.
Q: Can the KY and KU modifiers be billed together on specific complex rehab manual and power wheelchair accessories.
A: Yes.
Q: Is the KY modifier still required on certain option codes used with complex rehab manual and power wheelchair bases for beneficiaries in former competitive bid areas (CBAs)?
A: Yes