DME and KV Modifier

[Cwirtalla]

I have been running into trouble with Knee brace denials that need to be billed with the KV modifier to Noridian . The trouble I am having is that our Medicare patients come back in for a DME fitting for the brace with a MA, and we are unable to bill an E/M out. Due to this I can not use the KV. Is anyone else having this problem and if so what are you doing? I am also wondering if we put this DME fitting with a PA can we bill an office visit for the fitting?

Any advice would be much appreciated.

C. Wirtalla

 

[corrihar]

I googled KV and it is for walkers and wheelchairs. Seems more appropriate to use KX which is what our clinic uses to bill DME to Medicare.

 

[Cwirtalla]

We also use the KX, but because we are in a CBA we must use the KV in addition to the KX for Round2021.

 

[klamond]

Due to the competitive bidding round, KV is required for certain knee and spine orthosis. However, they will not pay for the DME unless an office visit was performed the same day (learned this the hard way).