On May 14, 2020 a Joint DME MAC Bulletin Article was published to provide guidance on use of the KX modifier. Use of the KX modifier indicates that specific required documentation is on file in the patient's medical record. CMS' final rule, which was retroactive to March 1, 2020, signficantly expanded access to services during the pandemic.
Effective for claims with dates of service on or after March 1, 2020 and for the duration of the COVID-19 Public Health Emergency (PHE), for the following LCDs in which the Face-to-Face evaluation or other services with an implied Face-to-Face evaluation such as a home assessment are waived during the PHE, the supplier must append the KX modifier if all other requirements specified in the policy are met:
- Knee Orthoses (L33318)
- Manual Wheelchair Bases (L33788)
- Negative Pressure Wound Therapy Pumps (L33821)
- Power Mobility Devices (L33789)*
- Pressure Reducing Support Surfaces - Group 1 (L33830)
- Pressure Reducing Support Surfaces - Group 2 (L33642)
- Pressure Reducing Support Surfaces - Group 3 (L33692)
- Speech Generating Devices (SGD) (L33739)
- Tumor Treatment Field Therapy (TTFT) (L34823)
- Urological Supplies (L33803)
- Wheelchair Options/Accessories (L33792)
- Wheelchair Seating (L33312)
*For Power Mobility Devices (PMDs), the face-to-face encounter with the ordering practitioner is mandated by Medicare statute at section 1834(a)(1)(E)(iv) of the Social Security Act, as codified in 42 CFR ยง 410.38. The regulation already permits the use of telehealth in accordance with Medicare guidelines. CMS has extended flexibilities to permit a broader use of telehealth services, locations, provider types and technologies during the COVID-19 PHE.
For the following LCDs, the supplier must append the KX modifier if all the requirements specified in the policy are met:
- Ankle-Foot/Knee-Ankle-Foot Orthosis (L33686)
- Automatic External Defibrillators (L33690)
- Cervical Traction Devices (L33823)
- Commodes (L33736)
- Glucose Monitors (L33822) - with the exception of CGM as noted below
- Hospital Beds And Accessories (L33820)
- Immunosuppressive Drugs (L33824)
- Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) (L33827)
- Orthopedic Footwear (L33641)
- Patient Lifts (L33799)
- Refractive Lenses (L33793)
- Transcutaneous Electrical Nerve Stimulators (TENS) (L33802)
- Walkers (L33791)
Additionally, suppliers should continue to bill the KX and/or CG modifiers for which LCDs' clinical indications of coverage are not being enforced. For those LCDs listed below, application of the KX or CG modifier attests that a Standard Written Order (SWO) is on file for the item and the medical record supports the item is reasonable and necessary:
- Oxygen and Oxygen Equipment (L33797)
- Positive Airway Pressure Devices for the Treatment of Obstructive Sleep Apnea (L33718)
- Oral Appliances for the Treatment of Obstructive Sleep Apnea (L33611)
- Respiratory Assist Devices (L33800)
- Mechanical In-exsufflation Devices (L33795)
- High Frequency Chest Wall Oscillation (L33785)
- Nebulizers (L33370)
- Glucose Monitors (L33822) - Only clinical indications for Therapeutic Continuous Glucose Monitors (CGM) are not enforced
- External Infusion Pumps (L33794)
Suppliers are reminded to append a CR modifier and include a narrative of "COVID-19" to all claims that are affected by the COVID-19 PHE. The narrative should be entered into the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format, field 390-BM of the National Council for Prescription Drug Program (NCPDP) format, or Item 19 of paper claims.
This enforcement discretion will only apply during the PHE for the COVID-19 pandemic. At the conclusion of the PHE for the COVID-19 pandemic, the DME MACs will return to enforcement of these requirements.