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ZX, KX, What's Next?

What does the KX modifier really mean? We know we need to add it to get reimbursed for some claims, but that's just the beginning. Prior to the the same
by Jane Bunch

What does the KX modifier really mean? We know we need to add it to get reimbursed for some claims, but that's just the beginning.

Prior to the “KX,” the same modifier was called a “ZX,” but even though its name changed in 2002, the meaning of the modifier did not. The KX modifier is added to claims for equipment that once required a certificate of medical necessity (CMN) or that currently require a written order prior to delivery (WOPD).

When you bill a claim requiring the modifier by policy, make sure you understand what you need in the patient's file prior to adding the modifier. Verify that intake and billing personnel read the entire policy for each item requiring the modifier, and that the patient qualifies under Medicare guidelines. You must have the documentation in the patient's file when adding the modifier to the claim and transmitting it.

The following equipment and/or supplies require a KX modifier:

  • Diabetic shoes and inserts
  • Urological supplies
  • Group I support surface
  • Group II support surface
  • Diabetes monitor and supplies (insulin dependent)
  • Dialysis supplies (epoetin alpha-epo)
  • Refractive lenses
  • Bedside commodes (effective April 1, 2005)
  • Cervical traction equipment (E0849)
  • Orthopedic footwear
  • Continuous positive airway pressure (CPAP) devices & supplies
  • Respiratory-assist devices (K0532, K0533) and supplies on K0532
  • Heavy-duty bariatric walkers
  • Negative-pressure wound therapy pump
  • High-frequency chest wall oscillation devices

Let's review some of these items and what the KX modifier means for this equipment:

  • Heavy-duty bariatric walkers. The patient must qualify for a walker under Medicare guidelines and have a diagnosis warranting the need for the equipment. The KX modifier in this case justifies that the patient has been weighed within 30 days before the delivery date, and that must be documented on the physician's order (PO). The patient must weigh 300 pounds or more, and the equipment must justify the weight requirements under SADMERC guidelines.

  • Group I & Group II support surfaces. The provider must have a WOPD, meaning there is an order in the provider's hands before the equipment leaves the showroom or the warehouse. The WOPD cannot be only verbal, but it may be a fax, copy or an original signature.

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