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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.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
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  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. 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 CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. 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.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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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 MM11784External PDF 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 11784External PDF 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

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