Wiki Application of KX modifier for DME

[jmeiner]

Billing Medicare for DME requires the KX or GY modifier, depending on the DME. We are billing for Custom Orthotics L3000 and AFOs for the most part. Can anyone tell me if the KX modifier should be used for claims going to Commercial plans? Does anyone have a reference for the answer? Thanks for any help

 

[amyjph]

You would have to check each payer's DME and/or modifier policy to see what they expect on DME claims. There is not one all or never answer for this.
Example: https://prc.hmsa.com/s/article/Billing-for-DME
This is not a KX policy, but an example of a DME RR/NU modifier policy: https://providers.anthem.com/docs/gpp/NV_CAID_RP_DMEModifiers.pdf?v=202101082036