Competitive Bid Modifiers for Complex Rehab Wheelchairs

When billing accessories on complex rehab wheelchair base in a competitive bid area, the attached charts need to be referenced.  There is a chart for Round 1 Rebid and a different chart for Round 2.  As of right now, all the DME MACs are paying with the KY modifier for the complex group 3 base accessories. The KE modifier is working for the manual complex wheelchair for Jurisdictions B, C and D; Jurisdiction A has a request in for updating their system to accept the KE for the manual complex wheelchair accessories on K0005 and E1161. We have attached the 2 charts to reference which are also being referenced by the DME MACs when billing accessories on a complex rehab wheelchair base.

If you are experiencing problems in your Jurisdiction with these modifiers, please contact Peggy Walker or Ronda Buhrmester at the contact information below.

 

Peggy Walker                                                                    Ronda Buhrmester

800-401-3643                                                                     888-665-6518

[email protected][email protected]             [email protected]

Round 1 Rebid Modifiers

KK, KG, KE

Accessory Code E0950 used with a:

Base Code Competitive Bid Status

Beneficiary Permanently Lives in CBA

Beneficiary Permanently Lives Outside a CBA

Manual Wheelchair (K0001-K0009) or Miscellaneous Power Wheelchair (K0898)

Nonbid

Bill with KE modifier

Bill with KE modifier

Standard Power Wheelchair

(K0813-K0829)

Bid in Round 1 and the Round 1 Rebid

Bill with KG modifier

Bill without KE modifier

Complex Rehabilitative Group 2 Power Wheelchair

(K0835-K0843)

Bid in Round 1 and the Round 1 Rebid

Bill with KK modifier

Bill without KE modifier

Complex Rehabilitative Group 3 Power Wheelchair

(K0848-K0864)

Bid in Round 1

Bill without KE, KK or KG modifier

Bill without KE modifier

 

 

 

Round 2: Modifiers KE and KY

Accessory Code E0950 used with:

Base Code Competitive Bid Status

Claim for a Beneficiary who Permanently Lives in a CBA

Payment Basis in CBA

Claim for a Beneficiary who Permanently Lives Outside a CBA

Payment Basis Outside CBA

Manual Wheelchair (K0001-K0004, K0006, K0007)

Bid in Round 2 (not bid in Round 1)

Bill without KE or KY modifier

Single Payment Amount (SPA)

Bill with KE modifier

**Fee Schedule

Standard Power Wheelchair (K0813-K0829)

Bid in Round 2 (bid in Round 1)

Bill without KE or KY modifier

SPA

Bill without KE modifier

*Fee Schedule

Complex Rehabilitative Group 2 Power Wheelchair (K0835-K0843) and Complex Rehabilitative Group 3 Power Wheelchair (K0848-K0864)

Not bid in Round 2 (bid in Round 1)

Bill with KY modifier

*Fee Schedule

Bill without KE modifier

*Fee Schedule

Manual Wheelchair (K0005, K0009) or Miscellaneous Power Wheelchair (K0898)

Not bid in Round 2 (not bid in Round 1)

Bill with KE modifier

**Fee Schedule

Bill with KE modifier

**Fee Schedule