Don’t Leave Money on the Table!

If you are providing group 3 power bases and you are not adding the KU modifier to the affected codes you are losing approximately $1000-$1500 in the allowed amount per claim! This applies to repair parts used on a group 3 base as well such as motors, joystick, replacement batteries, etc.

The KU should be used in these situations regardless of where the beneficiary resides (competitive bid area or not)!

Example
E1007 Tilt and Recline
Allowable without the KU: $7456.10
Allowable WITH the KU: $8387.40

That’s $931.30 left on the table just for that one code without the KU modifier. And the KU can be used on most codes used on group 3 bases with a few exceptions such as the E2313 and any manually priced codes such as K0108, E2609 and E2617.  See affected code list and use the KU when appropriate and don’t leave that money on the table!

If by chance you missed using the KU when appropriate, you can submit a written reopening a year from the date of service requesting to have the KU modifier appended to the codes listed (you must list the codes on the request). To check if you missed the KU on previous group 3 claims, review an old EOB and check the amount allowed and compare it to the fee schedule with KU. If it’s a group 3 base and the allowed amount for E1007 is $7456.10, you were underpaid. Submit a written reopening. Remember again this is just one of the codes. All codes on the Affected Code List should be checked.

Any questions, contact Dan at 570-499-8459 or dan.fedor@vgm.com.

Dan Fedor
Reimbursement Specialist, U.S. Rehab
Proud Employee Owner
P: 844-794-8459
F: 844-307-5729
E: dan.fedor@vgm.com