January 5, 2021
Adding the KE Modifier: Instructions for Reopening a Claim Adjusted Under the CARES Act
While there are some claims still in varying stages of the adjustment process, CGS can begin accepting Reopenings to add the KE modifier on applicable claims.
Based on the Cures CARES Act, the KE modifier can be added to certain accessories used with a non-competitive bid base for dates of service March 6, 2020 through April 22,2020 in non-rural areas. Claims that meet the criteria for addition of the KE modifier under the Cures Act must be submitted using the special Reopening Request Form: Multiple Claims/Beneficiaries.
Many of you may have multiple claims requiring addition of the KE modifier. CGS will accept those via spreadsheet. If using a spreadsheet, CGS asks that you use the Multiple Claim Beneficiary Form we have created OR you may create your own as long as it contains the following information:
- The beneficiary's name
- The MBI of the beneficiary
- The specific date(s) of service
- HCPCS code
- The supplier's PTAN
- Clearly state what addition or change is needed.
- The printed name and signature of the person filing the request
NOTE: BEFORE preparing your spreadsheet, you must make certain that the claim(s) have completed processing. Refer to your Medicare Remittance Advice statements. Once you have confirmed the claim(s) have completed processing, you may add the required information to the spreadsheet.
- CGS cannot accept more than 250 claims per spreadsheet
- Each spreadsheet can only be for one PTAN
- You must include one (1) completed Reopening Request Form: Multiple Claims/Beneficiaries https://cgsmedicare.com/pdf/dme_reopening.pdf form with each spreadsheet
Jurisdiction C suppliers may fax their Reopening Request form and Multiple Claims Beneficiary form and spreadsheet to 615.782.4649. If you wish to mail the information to Jurisdiction C, please send it to:
CGS Jurisdiction C
PO Box 20010
Nashville, TN 37202
Jurisdiction B suppliers may fax their Reopening Request form and Multiple Claims Beneficiary form and spreadsheet to 615-660-5978. If you wish to mail the information to Jurisdiction B, please send it to:
CGS Jurisdiction B
PO Box 20017
Nashville, TN 37202
CGS has published this information to our dedicated MM9968 11784 webpage! Click on the banner on the jurisdiction homepage to see the most recent information as well as related links