Wiki KX Modifier

donnareese

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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.

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

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.
 
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