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July 1, 2024

Utilizing Modifier KX for Medicare Dental Claims

In general, modifier KX is reported on a Medicare Part B claim to indicate:

  • A service or item is medically necessary; and,
  • The provider has appropriate documentation in the medical record to support or justify medical necessity.

Beginning on July 1, 2024, providers may also report modifier KX on claims for dental services to expedite a MAC's determination of inextricable linkage if:

  • A physician, including a dentist, is certain they possess information to support that the dental services are inextricably linked to a covered medical service that demonstrates adherence to the requirements of this policy; and,
  • Coordination of care between the medical and dental practitioners occurred and meets the payment policy criteria.

Providers are encouraged (but not currently required) to include modifier KX on dental claims to indicate:

  • The dental service is medically necessary;
  • The provider included appropriate documentation in the medical record to support or justify the medical necessity of the service or item and demonstrates the inextricable linkage to covered medical services; and,
  • Coordination of care between the medical and dental practitioners occurred.

Beginning on January 1, 2025, MACs may deny dental claims that do not contain modifier KX as statutorily non-covered.

For additional information, please review Change Request (CR) 13649PDF and the CMS Medicare Dental CoverageExternal Website page.

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