Knowledge Base Article

Q:

What is the KX modifier and when should it be used?

A:

The KX modifier is defined as “Requirements specified in the medical policy have been met.” It is a multipurpose informational modifier.

CMS has further defined some specific circumstances when providers should report the KX modifier.

• To report an automatic exception to therapy caps. Adding the KX modifier to the line items that exceed the therapy caps indicates that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.
• When billing for permanent cardiac pacemakers under the latest NCD revision effective August 13, 2013. Appending the KX modifier is an attestation by the provider that documentation is on file verifying the patient has non-reversible symptomatic bradycardia.
• To bill additional optional sessions of cardiac rehab or pulmonary rehab. Medicare allows 36 sessions, with the option for an additional 36 sessions for each of these services. Sessions beyond the initial 36 sessions, up to 72 sessions, require the KX modifier.
• To report FDG PET scans for subsequent treatment strategy beyond the 3rd scan. Each different cancer diagnosis is allowed one (1) initial treatment strategy (-PI modifier) FDG PET Scan and three (3) subsequent treatment strategy (-PS modifier) FDG PET Scans without the -KX modifier. The fourth FDG PET Scan and beyond for subsequent treatment strategy for the same cancer diagnosis will always require the -KX modifier.
• On MRIs for patients with implanted pacemakers that are FDA-approved for use in an MRI environment.Inclusion of the KX modifier on the claim line(s) means that the provider attests that documentation is on file verifying that FDA-approved labeling requirements are met.