KX Modifier for DME Eligibility

In the coding world, the "KX" modifier is added to claims for equipment that once required a certificate of medical necessity (CMN) or that currently require a written order prior to delivery (WOPD). Adding the "KX" modifier to CPT (Current Procedural Terminology) codes can help to get the claim paid more quickly and accurately. Since June 30, 2009, Humana has required the use of the "KX" modifier, when appropriate, for certain durable medical equipment (DME). Starting on Sept. 30, 2009, Humana will no longer reimburse claims submitted without the appropriate modifiers.

The "KX" modifier, when appropriate, must be included with claims for the following items:

Appending the "KX" modifier attests that a medical practice has completed the required documentation of medical necessity, and therefore, the billed equipment meets Humana's coverage criteria. Physician practices are responsible for confirming and maintaining evidence of medical necessity. Although the "KX" modifier indicates that requirements for coverage have been met, the "KX" modifier does not replace the need for preauthorization. The "KX" modifier should be inserted in the "modifier" field on a submitted claim. The modifier may be in any position, but it must be appended to the line that pertains to the specific DME item.

Humana's determinations for coverage and modifier requirements are consistent with the Centers for Medicare & Medicaid Services (CMS) policies.

For additional information, visit the secure provider area on Humana.com, which requires registration to access. Once registered, click on the link for the Code Editing Question (CEQ) within the "Claims" window.

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