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December 15, 2020

Glucose Monitors - Correct Coding of KX and KS Modifiers

Recent review of claims for home blood glucose monitors and supplies reveals there is often discrepancies between the beneficiary's diagnosis and/or insulin use as described on the order versus the documentation in the beneficiary's medical record.

This often occurs with supplier-generated orders which are prepared by the supplier for signature by the treating practitioner. In some cases, the treating practitioner indicates the beneficiary is not insulin dependent. For example, the order (and the claim) indicates the beneficiary does not use insulin (modifier KS) but the beneficiary's medical record documents insulin use (modifier KX). Suppliers are reminded that the coverage criterion, upon which modifier KX or KS use depends on, is determined by whether or not the beneficiary uses insulin injections.

Terms like "Type 2 diabetic" or "non-insulin dependent" can be confusing and may not accurately indicate whether or not insulin is injected. Modifier KX must be used when billing glucose monitor supplies for beneficiaries who are being treated with insulin injections. Modifier KS must be used when billing glucose monitor supplies for beneficiaries who are not being treated with insulin injections.

In situations where there is a conflict between the order and the documentation in the beneficiary's medical record, review staff base their determination, of correct modifier use and the associated utilization guideline, on the information in the beneficiary's medical record.

In no circumstance should both the KX modifier and the KS modifier be appended to a single claim line.

Suppliers should review the entire Glucose Monitors LCD and Policy Article for additional information on coding, coverage and documentation requirements.

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