At the first of the year, CMS ended all competitive bid contracts and restored the any-willing-provider arrangement nationwide. The competition gap ushers in a new set of rules for competition-related product and modifier combinations.
The following quick review lists will help billers to determine which modifiers apply during the gap:
Do not use the following modifiers during the gap:
Do use the following modifiers for all beneficiaries with these services:
For beneficiaries with a permanent residence in a former Competitive Bid Area (CBA), use the following modifiers:
For beneficiaries with a permanent address in rural and non-contiguous areas, use the KE modifier for the following accessories:
Make sure your staff understands the meaning of these modifiers and when to apply them. Several of them drive higher compensation, but only when used appropriately. Suppliers that fail to use these modifiers correctly will experience rejections, recoupments, or underpayments.
SOURCE LINKS
https://cgsmedicare.com/jc/pubs/news/2019/01/cope10661.html
The following quick review lists will help billers to determine which modifiers apply during the gap:
Do not use the following modifiers during the gap:
- KT for traveling beneficiaries.
- KV for physician-related DME services.
- J4 for hospital furnished DME.
Do use the following modifiers for all beneficiaries with these services:
- KL for all home-delivery diabetic supplies.
- KU for wheelchair accessories and cushions furnished with Group 3 PWC bases (K0848-K0864).
For beneficiaries with a permanent residence in a former Competitive Bid Area (CBA), use the following modifiers:
- KG for the following accessories:
- E0776BA (if used with B9002).
- A7005 (if used with E0570, E0572, or E0585).
- A7000 (if used with E2402).
- A4557 (if used with E0720 or E0730).
- A4595 (if used with E0720 or E0730).
- E0731 (if used with E0720 or E0730).
- E0156 (if used with E0130, E0135, E0140, E0141, E0143, E0148, or E0149).
- KY for wheelchair accessories (used with one of these bases: K0005, K0009, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0898, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, or E1239).
For beneficiaries with a permanent address in rural and non-contiguous areas, use the KE modifier for the following accessories:
- E0776 (used with parenteral nutrition).
- A7000 (used with suction pumps).
- A4636 (used with canes or crutches).
- A4637 (used with canes or crutches).
- Wheelchair accessories (used with one of these bases: K0001, K0002, K0003, K0004, K0005, K0006, K0009, K0898, E1161, E1229, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239).
Make sure your staff understands the meaning of these modifiers and when to apply them. Several of them drive higher compensation, but only when used appropriately. Suppliers that fail to use these modifiers correctly will experience rejections, recoupments, or underpayments.
SOURCE LINKS
https://cgsmedicare.com/jc/pubs/news/2019/01/cope10661.html
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