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Eli's Rehab Report

New DME Modifier Introduced

Published on Mon Apr 01, 2002 Print Friendly and PDF PDF

Introduction of national modifier -KX (Specific required documentation on file), effective for durable medical equipment (DME) claims submitted for dates of service on or after July 1, 2002, will also affect many PM&R practices. The modifier replaces local modifier -ZX (Specific requirements found in the Documentation section of the medical policy have been met and evidence of this is available in the suppliers records), which will no longer be recognized after the three-month grace period ends on Oct. 1, 2002. CMS Program Memorandum B-02-003 states that -KX is required only on claims where national policy or LMRPs [local medical review policies] specifically require its use for a particular item or service. For instance, a claim for orthopedic footwear such as L3030 (Foot insert, removable, formed to patient foot, each) is covered if it is for a shoe that is an integral part of a brace and medically necessary for the proper functioning of the brace. The regional DME carriers required the addition of  -ZX for such claims, but now DME carriers should be sure to replace that with -KX instead. 
 
Note: CMS Program Memorandum B-02-003 can be found at www.hcfa.gov/pubforms/transmit/B02003.pdf.

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