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

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

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

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
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January 4, 2019 - Revised: 02.03.20

Appropriate Modifiers during the Temporary Gap in Competitive Bidding

All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program (CBP) contracts expire on December 31, 2018. Starting January 1, 2019, there will be a temporary gap in the DMEPOS CBP that CMS expects will last until December 31, 2020.

Effective for dates of service on or after January 1, 2019 and during this temporary gap period, the following modifiers will be invalid for claim submission:

  • KT Modifier - Beneficiary resides in a CBA and travels outside that CBA and receives a competitive bidding item
  • KV Modifier - DMEPOS item subject to DMEPOS Competitive Bidding Program that is furnished as part of a professional service
  • J4 Modifier - DMEPOS item subject to DMEPOS Competitive Bidding Program that is furnished by a hospital upon discharge

The following modifiers may be required depending upon the location where the beneficiary resides. Keep in mind, usage is based on the beneficiary's permanent address on file and not the supplier location.

All Locations:

The KL Modifier will continue to be required for mail order diabetic supplies. The KL modifier is used in addition to other required modifiers and must  be appended to any diabetic supplies (A4233, A4234, A4235, A4236, A4253, A4256, A4258, and A4259) ordered remotely and delivered to the beneficiary's home. This includes delivery via a company vehicle or common carrier. Any supplier is eligible to furnish mail order diabetic supplies during the temporary gap period.

The KU Modifier must continue to be used for wheelchair accessories and seat and back cushions which are furnished with a Group 3 Complex Rehab Wheelchair base. (K0848 – K0864). A list of applicable accessories is available in CR 9520External PDF. This requirement is based on the Patient Access and Medicare Protection Act (PAMPA) and is not directly related to the gap in competitive bidding.

Former Competitive Bid Areas Only:

The KG Modifier is required to identify accessories that are for use with a formerly competitive bid base. The KG is only appropriate for certain accessories which fall within more than one LCD and is important for appropriate pricing. The KG is required in former Competitive Bid Areas only for the following accessories:

Policy Group

KG Billed on the Following Accessories

For Use with the Following Base Equipment

Enteral Nutrition

E0776BA

B9002 (Note: Append the KG modifier to E0776BA when the CMN indicates administered by gravity or a pump.)

Nebulizers

A7005

E0570, E0572, and E0585

Negative Pressure Wound Therapy

A7000

E2402

TENS

A4557, A4595, E0731

E0720, E0730

Walkers

E0156

E0130, E0135, E0140, E0141, E0143, E0148, and E0149

If the above accessories are used with a different base, the KG modifier is not appropriate. Items billed with a KG modifier and no record of a qualifying base will be rejected.

The KY Modifier is used to identify a wheelchair accessory that is for use with a base that was not part of the competitive bid program. This modifier is only for use in former competitive bid areas and is important to ensure appropriate pricing on the wheelchair accessories. For example, a KY modifier would be appropriate in a former CBA for an E0950 (wheelchair tray) used with an E1161 (manual tilt in space wheelchair) base but not appropriate on an E0950 used with a K0823 (Group 2 Standard, Captains Chair) base.

Suppliers are encouraged to utilize the KE/KY Modifier Tool to identify which accessories should have a KY modifier appended.

Claims for Beneficiaries Located in Rural Areas and Non-Contiguous States Only:

The KE Modifier is used on certain accessory codes that can be dually billed with either a formerly competitively bid or non-competitively bid base item. The KE is only appropriate for items which are not subject to the fee schedule reduction which occurred under the Medicare Improvements for Patients & Providers Act (MIPPA) of 2008. The KE modifier is only applicable in rural areas and non-contiguous states where the fee schedule is based on the 50/50 blend. KE fees will be listed on the fee scheduleExternal Website for the applicable codes; however those higher fees are only applicable if the accessory is for use with a base that was not included in the 2008 Original Round 1 of competitive bidding.

Suppliers are encouraged to utilize the KE/KY Modifier Tool to identify which accessories should have a KE modifier appended.

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