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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:

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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