Wiki Injection denial for UHC Medicare Replacement plan

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Augusta, GA
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We have been getting several denials for j2920 asking for a modifier. When we call they are saying add a KX mod. Do anybody have any info on this? We have been searching for all kinds of policy on this and we have gotten paid prior dates of service been it seems like a new issue now. Thanks in advance
 
You shouldn't need a KX modifier unless there is a benefit max. We have only had to use that on Physical Therapy for regular Medicare patients.

Are you reporting the NDC number on that line on the claim? This year we have had to report the NDC on all drugs for UHC in order to get paid. It was an injectable drug policy update.
 
UHC Policy

According to the current UHC Medicare Advantage Policy Guidelines, J2920 does require the KX modifier in addition to the requisite NDC code. There is a file embedded in their policy (KX Modifier HCPCS Coding.xls) that you can save down that provides a list of all of the HCPCS codes they are requiring this modifier to be used on. Of note, the Chrome browser has not been historically favorable with my attempting to save down the files embedded in their policies, I typically have to use Internet Explorer.

Hope the above is of some help, though even when outlined in their policies there is no guarantee it will resolve claim issues, nor do you often get an explanation as to why some claims processed without a modifier and some won't...we all know how much fun it is to work with UHC :rolleyes:

Good luck!
 
https://www.aapc.com/memberarea/forums/153930-injection-denial-uhc-medicare-replaceme

We are starting to see these denials as well in our practice.

Can someone tell me should modifier KX be added to J2920 or to the admin charge? Everything I read seems to point to add to the J2920, but not specific.

Is this just a UHC issue? or other Insurance company's following?

Also, have you noticed what the reimbursement is from UHC on the J2920?
 
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