Wiki UPT for Acutane- Mismatch gender

[kireland93]

Acutane requires UPT to make sure the patient is not pregnant for female patients, but we have a patient that was born a female and has changed their gender legally through Medicaid, but the UPT charges are not being paid due to the gender mismatch, any suggestions on getting this paid?

 

[csperoni]

Look at modifier -KX.
From CMS: For Part B claims processing, the KX modifier shall be billed on the detail line with any procedure code(s) that are gender specific. The definition of the KX modifier is: Requirements specified in the medical policy have been met. Use of the KX modifier will alert the MAC that the physician/practitioner is performing a service on a patient for whom gender specific editing may apply, but should have such editing by-passed for the beneficiary. The CWF shall override any gender specific edits for procedure codes billed with the KX modifier and allow the service to continue normal processing.

 

[kireland93]

Look at modifier -KX.
From CMS: For Part B claims processing, the KX modifier shall be billed on the detail line with any procedure code(s) that are gender specific. The definition of the KX modifier is: Requirements specified in the medical policy have been met. Use of the KX modifier will alert the MAC that the physician/practitioner is performing a service on a patient for whom gender specific editing may apply, but should have such editing by-passed for the beneficiary. The CWF shall override any gender specific edits for procedure codes billed with the KX modifier and allow the service to continue normal processing.

Awesome, thank you so much!