CMS Clarifies Modifier KY Use

The Centers for Medicare & Medicaid Services (CMS) recently clarified when modifier KY DMEPOS item subject to DMEPOS competitive bidding program number 5 should be used to report durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) subject to competitive bidding, and hinted to a change in policy that may be forthcoming.

Prior to phase 1 of the DMEPOS competitive bidding program, which began Jan. 1, CMS developed a number of HCPCS Level II modifiers for the reporting of certain DMEPOS items and services provided to Medicare beneficiaries in a competitive bidding area (CBA). The descriptions for these modifiers have not changed but CMS clarifies the use of modifier KY in a revised transmittal, issued Jan. 10.

Non-contract grandfathered suppliers furnishing DMEPOS items or services for use with rented, grandfathered equipment to Medicare beneficiaries in an appointed CBA on or after Jan. 1 should continue to report modifier KY on claims.

When appropriate, append modifier KY to the following HCPCS Level II codes:

  • Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assistive Devices, and Related Supplies and Accessories – A4604, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, E0562
  • Hospital Beds and Related Accessories – E0271, E0272, E0280, E0310
  • Walkers and Related Accessories – E0154, E0156, E0157, E0158

Here’s the foreshadowing: “Until notified otherwise, grandfathered suppliers that submit claims for the payment of the aforementioned purchased accessories and supplies for use with grandfathered equipment should submit the applicable single payment amount for the accessory or supply as their submitted charge on the claim.”

And here’s the clarification: “After the rental payment cap for the grandfathered equipment is reached, the beneficiary must obtain replacement supplies and accessories from a contract supplier. The supplier of the grandfathered equipment is no longer permitted to furnish the supplies and accessories once the rental payment cap is reached.”

See revised MLN Matters SE1035 for complete details.

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