Is it possible that there are more than four appropriate modifiers involved and the following may apply? It is the only thing I can think of right now.
When more than four modifiers are required on a claim line suppliers should append the 99 modifier in the fourth two-digit position. If the item requires a pricing modifier NU, RR, or UE along with the KE pricing modifier, the NU, RR or UE modifier should be placed in the first position following the Healthcare Common Procedure Coding System (HCPCS) code and the KE modifier should be placed in the second position. If the item also requires a capped rental modifier (KH, KI, KJ, KR, MS, BR, BP or BU), it would be placed in the third position followed by any subsequent informational modifiers (RT, LT, RA, RB, GA, etc.). If the item requires a KX modifier, we suggest the KX modifier be placed on the claim line. However, if the claim line necessitates the use of more than four modifiers, the 99 modifier must be placed in the fourth two-digit position. Suppliers should then list all of the modifiers in Item 19 for hardcopy claims or in the NTE segment for electronic claims. The modifiers should be listed first before any other narrative information and should not include any spaces.
â€¢Example: NTE segment for electronically submitted claims all modifiers (RR, KE, KH, BR, and KX).
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