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Billing Reminder: Claim Submission When More Than Four Modifiers are Required Effective January 1, 2009, the KE modifier became required for supplies and accessories used with both competitively bid and non-competitively bid items. Because of the addition of the KE modifier, claims now frequently require more than four modifiers. National Government Services, the Jurisdiction B Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) would like to take this opportunity to remind suppliers about proper claim submission when more than four modifiers are required on a claim line. 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 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. Example: NTE segment for electronically submitted claims all modifiers (RR, KE, KH, BR, and KX). NOTE: Electronic submitters should verify that the HCPCS and modifiers are transmitted electronically in upper case. Suppliers should contact their software vendor, billing service or clearinghouse if they are unsure whether the information is transmitted using upper case letters. If the HCPCS and/or the modifiers are transmitted in lower case, the electronic trading partner will receive the C172 edit on the electronic GenResponse Report they receive from CEDI. In situations where more than 4 modifiers are required, the beneficiary requests an upgrade, and suppliers have properly executed an ABN suppliers must append the KB modifier. When submitting a claim with the KB modifier, the supplier should first place the pricing modifier(s), followed by informational modifiers, and then place the KB modifier in the fourth modifier position. Any remaining modifiers should be placed in Item 19 for paper submitted claims or in the NTE segment for electronically submitted claims. Example: NTE segment for electronically submitted claims the remaining modifiers (BR, and GK/GL modifiers). For additional information concerning HCPCS modifiers suppliers should refer to the Jurisdiction B DME MAC Supplier Manual, Chapter 14 which can be located on the National Government Services Web site at: http://www.ngsmedicare.com/ngsmedicare/DMEMAC/EducationandSupport/ ToolsandMaterials/SupManual/chapter14.aspx |
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