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July 17, 2020

KU Modifier Claim Reopening Requests for Certain Accessories in Connection with Complex Rehabilitative Manual Wheelchairs & Certain Manual Wheelchairs

Background

The Further Consolidated Appropriations Act, 2020 (Pub.L. 116-94) was signed into law on December 20, 2019.  Section 106 of the Further Consolidated Appropriations Act, 2020 mandates the non-application of fee schedule adjustments based on information from competitive bidding programs for wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with complex rehabilitative manual wheelchairs (HCPCS codes E1161, E1231, E1232, E1233, E1234 and K0005) and certain manual wheelchairs currently described by HCPCS codes E1235, E1236, E1237, E1238, and K0008 during the period beginning on January 1, 2020 and ending June 30, 2021.

Claim Reopening Requests

DME suppliers may begin submitting reopening requests to add the KU modifier to certain accessories furnished in connection with certain manual wheelchairs (E1161, E1231-E1238, K0005, and K0008).  For a complete list of the accessory codes eligible for reopening, see Attachment AExternal PDF.

Claims for these accessories submitted prior to July 1, 2020, with dates of service January 1, 2020 through June 30, 2020, without the KU modifier can be submitted as claim reopenings on or after July 1, 2020.  Claims submitted prior to July 1, 2020 must be submitted as claims reopenings to receive the unadjusted fee schedule amounts. 

A Reopening Request Form should be completed and faxed to the DME MAC, to have the KU modifier added to accessories listed in Attachment A.

Claim Reopening Request Form Instructions

The Reopening Request Form should include:

  1. For "Supplier Information" – Complete all fields
    1. IMPORTANT – list all PTANS for which you're requesting these reopenings
  2. For "Beneficiary Information" – Complete only as follows:
    1. Reason for adjustment: Check "Other"
    2. Comments: State "Please adjust my previously processed claims for the PTAN(s) listed above for the HCPCS covered in CR 11635"
      1. No other beneficiary information is required on the Reopening Request Form (i.e., beneficiary name, Medicare number, address, etc.), date of service, HCPCS, or Claim Control Number.
  3. Fax the completed form to the DME MAC fax number located at the bottom of the Reopening Request Form.
  4. Completed DME MAC Reopening Request Form example:

    Screen Shot

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