Wiki KX Modifier

[donnareese]

Recently i have questions about KX modifier. The description i have seen in Codify it is defined as a special circumstances modifier for PT, OT or SP services. However, I have seen where it is used and approved by CMS for use with pacemaker placements. (33274) Can I get further guidance on this modifier and what is required to be documented please.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54831&ver=26&keyword=&keywordType=starts&areaId=all&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=33274&hcpcsEndCode=33274&sortBy=title&bc=1

 

[swetap]

Hi Donnareese, this modifier KX is used by providers when they deems continued care medically necessary only for Medicare. Thank you!

 

[leagle]

Recently i have questions about KX modifier. The description i have seen in Codify it is defined as a special circumstances modifier for PT, OT or SP services. However, I have seen where it is used and approved by CMS for use with pacemaker placements. (33274) Can I get further guidance on this modifier and what is required to be documented please.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54831&ver=26&keyword=&keywordType=starts&areaId=all&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=33274&hcpcsEndCode=33274&sortBy=title&bc=1

Hi Donna,

I work in therapy and we use it when a patient exceeds the initial therapy threshold to indicate services continue to be medically necessary. I don't think it would apply to one time procedures like pacemaker placements after reviewing the Medicare claims processing manual as it's only mentioned in conjunction with therapy. BUT, should I be wrong there, it does signify that medical necessity has been confirmed and is reflected in the documentation.