Modifiers
| Modifier | Brief Description |
| Mod 99 | Modifier overflow |
| Mod A1 | Dressing for one wound |
| Mod A2 | Dressing for two wounds |
| Mod A3 | Dressing for three wounds |
What does DME stand for in medical terms?
Definition; DME: Durable Medical Equipment: DME: Distance Measuring Equipment: DME: ...
What does DME stand for in auto?
The comprehensive management system for your engine: Digital Motor Electronics (DME) controls all key aspects of the engine's operation, ensuring optimum reliability, maximum performance and the lowest possible fuel consumption and emissions.
What is DME and what is it used for?
To qualify as DME, the item must:2
- Primarily serve a medical purpose
- Be prescribed by or ordered by a medical provider
- Be able to be used again and again
- Generally have an expected lifetime of at least three years
- Be used in the home
- Only be useful to patients who have an injury or disability
What is DME in healthcare?
Durable medical equipment (DME) refers to a specific medical term used by health insurance companies like Medicare, Medicaid, and private companies. DME is any medical device or supplies that are necessary for a person’s health, which can be used for a long-term basis.
Does DME need a modifier?
In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item.
What is KX modifier for DME?
The KX modifier represents the presence of required documentation is on file to support the medical necessity of the item.
What is a RR modifier used for?
Payment is based on the monthly fee schedule amount until the medical necessity ends. No payment is made for the purchase of equipment, maintenance and servicing or for replacement of items. Use the RR (Rental) modifier for items in this category....Edit This Favorite.Edit This FavoriteShare:Yes No, Keep Private3 more rows
What is the KJ modifier?
Modifier KJ DMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, months four to fifteen.
What is Medicare KX modifier?
The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.
What is KP modifier?
When two NDCs are submitted on a claim, a KP modifier (first drug of a multiple drug unit dose formulation) is required on the first detail and a KQ modifier (second or subsequent drug of a multiple drug unit dose formulation) is required on the second detail.
What is modifier QL?
Providers and suppliers must use the modifier QL (Patient pronounced dead after ambulance called) to indicate the circumstance when an air ambulance takes off to pick up a beneficiary but the beneficiary is pronounced dead before the pickup can be made.
What is an FS modifier?
Modifier FS This modifier is used to indicate the service was a split or shared evaluation and management (E/M) visit.
What is modifier RI?
These modifiers are. LM (left main coronary artery), RI (ramus intermedius coronary artery), 24 (unrelated evaluation and. management service by the same physician during a postoperative period), and 57 (decision for surgery).
What is the TC modifier?
Modifier TC is used when only the technical component (TC) of a procedure is being billed when certain services combine both the professional and technical portions in one procedure code. Use modifier TC when the physician performs the test but does not do the interpretation.
Modifiers-a look
Not all HCPCS code requires a modifier to be added but most of it comes along with a modifier. Basically, a modifier conveys whether the item is new, used or rented on a capped basis, and when it comes to capped rentals, only modifiers show the difference of which month’s DME bill is being billed.
Maintenance and servicing
MS is the modifier that is used for a 6-month maintenance and servicing fee for required parts and labor that are not covered under any warranty of the supplier or the manufacturer. Moreover, maintenance and service payments are made every six months only after the member initially owns the equipment.
Replacement and repair
RA is the DME code applicable for the replacement of a DME item due to loss, non-repairable damage, or theft. But this modifier should be used only for the first month rental claim for a replacement item.
KX modifier for documentation on file
The KX modifier represents the presence of required documentation is on file to support the medical necessity of the item. The KX modifier is allowed for the following categories:
What percentage of Medicare payment does a supplier pay for assignment?
If your supplier accepts Assignment you pay 20% of the Medicare-approved amount, and the Part B Deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
What is Medicare approved amount?
Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. , and the Part B.
What is Medicare assignment?
assignment. An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance. you pay 20% of the. Medicare-Approved Amount.
Does Medicare cover DME equipment?
You may be able to choose whether to rent or buy the equipment. Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare.
When will Medicare change the KU modifier?
As aforementioned, these system changes will be implemented on July 1, 2020.
When to use KU modifier?
Suppliers should use the KU modifier for claims with dates of service on or after July 1, 2020 through June 30, 2021 for Attachment A codes that are furnished in conjunction with complex rehabilitative manual wheelchairs or certain manual wheelchairs.
What is Medicare Accessibility Act?
CMS is implementing the Patient Access and Medicare Protection Act to ensure that beneficiaries have access to wheelchair accessories and seat and back cushions when furnished with Group 3 complex rehabilitative power wheelchairs. To ensure beneficiary access to these accessories particularly for these vulnerable populations, advance payment may be available for suppliers. Prior to July 1, suppliers will be paid the adjusted fee schedule rates. The average reduction during this period for these items is approximately 10%. During this time, CMS has announced that suppliers are able to submit a single advance payment request for multiple claims if the conditions described in CMS regulations at 42 CFR Section 421.214 are met. Additional information is below.
What is gap filling in Medicare?
For newly covered items of DMEPOS paid on a fee schedule basis where a Medicare fee does not exist , the Centers for Medicare & Medicaid Services (CMS) uses a process to establish fees called gap-filling. This allows Medicare to establish a price that aligns with the statutory requirements for the DMEPOS fee schedule.
What is a DMEPOS file?
The DMEPOS public use file contains fee schedules for certain items that were adjusted based on information from the DMEPOS Competitive Bidding Program in accordance with Section 1834 (a) (1) (F) of the Act.
What is TTFT in Medicare?
TTFT is a system consisting of an electromagnetic field generator and transducer arrays and will be covered under the Medicare Part B benefit for durable medical equipment (DME) for items and services furnished on or after September 1, 2019.
What is a CGM?
CGMs are items of durable medical equipment (DME) that provide critical information on blood glucose levels to help patients with diabetes manage their disease . In January 2017, CMS issued a ruling providing for Medicare coverage of therapeutic CGMs.
What is a modifier in HCPCS?
In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item. For example, the modifier may tell HMSA that an item is new, used, or rented on a capped basis. For capped rentals, modifiers distinguish which month’s rental is being billed.
When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier (s) to describe
When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier (s) to describe the items being billed . Also, include an ICD-9/ ICD-10 diagnosis code indicating the medical condition for which the item has been prescribed.
What is the KB modifier?
The KB modifier only applies to beneficiary upgraded claims for DMEPOS where the supplier obtained an ABN and there are more than four modifiers on the claim line. The 99 modifier is used in any other situation when a claim line has more than four modifiers.
What is an inexpensive DME?
Routinely Purchased-This category consists of equipment that is purchased at least 75% of the time . Payment for this type of equipment is for rental or lump-sum purchase. The total payment may not exceed the actual charge or the fee for purchase. Common modifiers used in this category are:
