New KE modifier – Bid Under Round One of the DMEPOS Competitive Bidding Program for Use With Non-Competitive Bid Base / Equipment
Under round one of Competitive Bidding, certain accessories and supplies were included if they were to be used with an item or service that was in a competitively bid product category. However, many of these accessories and supplies might also be used with an item or service that was not included as a product category under competitive bidding. Starting 1/1/2009, if any of these accessories and supplies are billed with an item or supply that was not included in round one (manual wheelchairs), the KE modifier must be used.
If this modifier is used correctly, you will receive a 5 percent covered item update for 2009 for that accessory and it will not be subject to the 9.5 percent reduction. If the KE modifier is not used, there will be a 9.5 percent reduction in your allowable for that item. This applies to replacement items as well as those billed with bases at initial issue. The list of non-competitively bid manual chairs includes:
K0001 through K0009, K0830, K0831, K0898, E1050, E1060, E1070, E1083 through E1090, E1092, E1093, E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1190, E1195, E1200, E1220, E1221 through E1229, E1231 thru E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295
Note: The first part of the notice from CMS did not include tilt-in-space chairs, transport chairs or geri-chairs, however, when you look at the all-inclusive list, they have included all but the geri-chairs and transport chairs (E1031, E1038 and E1039).
If an accessory or supply is billed with an item or service that was included in round one of competitive bidding, then the KE modifier should not be used. In these cases, you will see a 9.5 percent reduction in your allowable for that item. This includes accessories and supplies used for scooters (codes K0800 through K0802, K0806 through K0808) and power chairs (codes K0813 through K0816, K0820 through K0829, K0835 through K0843, and K0848 through K0864). The accessories that were included under the respective product categories in round one of competitive bidding are listed below (again, they are subject to the 9.5 percent cut if used with a competitively bid product. They will receive a 5 percent covered item update for 2009 if used with a non-competitively bid manual base and if billed with the KE modifier):
Standard Power Accessories
E0950 through E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995, E1016, E1020, E1028, E2208, E2209, E2210, E2361, E2363, E2365 through E2371, E2381 through E2392, E2394, E2395, E2396, E2601 through E2608, E2611 through E2616, E2619, E2620, E2621, K0015, K0017 through K0020, K0037 through K0047, K0050 through K0053, K0098, K0195, K0733 through K0737,
Complex Rehabilitative Only Accessories
E1002 through E1008, E1010, E1029, E1030, E2310, E2311, E2321 through E2330, E2351, E2373 KC*, E2374 through E2377
(* When E2373 is used as a replacement only on a competitively bid complex rehabilitative product (K0835 – K0864), use the KC modifier but not the KE modifier. When used as a replacement only on a non-competitively bid manual or miscellaneous wheelchair, use the KE modifier, but not the KC modifier.)
The KE modifier should also be used for tips (A4637) and hand grips (A4636) when used on a non-competitively bid cane or crutch, but not when used for a competitively bid walker (E0130, E0135, E1040, E0141, E0143, E0144, E0147, E1048 or E0149).
The disposable canister code (A7000) requires the KE modifier when used with respiratory or gastric suction pumps, but not when used for a competitively bid negative pressure wound therapy (NPWT) pump (E2402).
When providing an IV pole (E0776) with non-competitively bid parenteral nutrient codes, use the KE modifier, but not the BA modifier. When providing the IV pole for competitively bid enteral nutrient codes (B4149, B4150 and B4152 through B4155) use the BA modifier, but not the KE modifier.
-The KE is a pricing modifier and will follow the NU and be in front of the KX – ie: NUKEKX
-For repairs the RP modifier is deleted as of 1/1/2009 and will be replaced by:
-RA — to be used when replacing a product (base item) in all categories.
-RB — to be used when replacing a specific part of another item – ie: when replacing an arm pad the code would require the NURB as well as the RT or LT and KX modifiers.
If you have any questions, please call Peggy Walker at 800-401-3643 or email: [email protected]