KE modifier Updates

U.S. Rehab Members:

For proper reimbursement on accessories provided on manual wheelchairs, be sure you are using the KE modifier appropriately!
 
The following was released by NHIC, Corp today, for providers in ALL Medicare Regions.  
Please see the recently published article below and the user guide provided.  
Remember this is based on Dates of Service (Delivery Date) on or after January 1st, 2009.

NHIC, Corp.
DME MAC A ListServe

For Immediate Release

January 06, 2009

ALERT – all suppliers are to use the KE modifier as appropriate per the instructions contained in this article, effective with dates of service on or after 1/01/09. Proper usage of the KE modifier will ensure appropriate payment amounts for those items and situations listed. Failure to use the KE modifier as appropriate will result in a 9.5% reduction in payment for these items. Follow the instructions given in the attached article and refer to

MM6270
for additional information. If a reduction in payment is received inappropriately, you may contact the telephone re-openings line at 317-595-4371 to request that the KE modifier be added to the claim. Please follow the guidelines for requesting a re-opening found on our Web site at:

http://www.medicarenhic.com/dme/contacts_appeals.shtml
. In addition, appending the KE modifier to a HCPCS code in error may cause a CO-4 rejection with the message "the procedure code is inconsistent with the modifier used." Claims rejected in this manner should be re-submitted without the KE modifier.

New KE Modifier Effective January 1, 2009

Suppliers must use the KE modifier to identify when the same accessory HCPCS code can be furnished in multiple competitive and non-competitive bidding product categories. For example, HCPCS code E0981 Wheelchair Accessory, Seat Upholstery, Replacement Only, Each can be used with both competitively bid standard and complex rehabilitative power wheelchairs (K0813 thru K0829 and K0835 thru K0864), as well as with non-competitively bid manual wheelchairs (K0001 thru K0009) or a miscellaneous power wheelchair (K0898). The KE modifier would be appended to the E0981 if it is an accessory for a K0001 manual wheelchair (the non-competitively bid base item).

The KE modifier is used to identify an accessory code that can be dually billed with either a competitive or non-competitive bid base item, the KE modifier must be appended to the accessory code if it is billed with a non-competitively bid base item.

Note: Suppliers should not use the KE modifier on any claims for items that were included under Round 1 of competitive bidding such as an accessory for a standard or complex rehabilitative power wheelchair.

Standard or Complex Rehabilitative Power Mobility Device Accessories

When billing a Column I accessory code for use with a base code in Column II, do not use the KE modifier. When billing a Column I accessory code for use with a base code in Column III, use the KE modifier.

Column I – Accessory

Column II – Power Mobility Device Base
(No KE Modifier)

Column III – Wheelchair Base
(KE Modifier)

E0950, E0951, E0952,
E0955, E0956, E0957, E0960, E0973, E0978, E0981, E0982, E0990, E0995,
E1016, E1020, E1028, E2208, E2209, E2210, E2361, E2363, E2365, E2366,
E2367, E2368, E2369, E2370, E2371, E2381, E2382, E2383, E2384, E2385,
E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396,
E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2611, E2612,
E2613, E2614, E2615, E2616, E2619, E2620, E2621, K0015, K0017, K0018,
K0019, K0020, K0037, K0038, K0039, K0040, K0041, K0042, K0043, K0044,
K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0098, K0195, K0733,
K0734, K0735, K0736, K0737
K0813, K0814, K0815,
K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828,
K0829, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843,
K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857,
K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864
K0001, K0002, K0003,
K0004, K0005, K0006, K0009, K0830, K0831, K0898, E1050, E1060, E1070,
E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093,
E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172,
E1180, E1190, E1195, E1200, E1220, E1221, E1222, E1223, E1224, E1225,
E1226, E1227, E1228, E1229, E1231, E1232, E1233, E1234, E1235, E1236,
E1237, E1238, E1239, E1240, E1250, E1260, E1270, E1280, E1285, E1290,
E1295

Complex Rehabilitative Power Mobility Device Only Accessories

When billing a Column I accessory code used with a base code in Column II, do not use the KE modifier. When billing a Column I accessory code used with a base code in Column III, use the KE modifier.

Column I – Accessory

Column II – Complex Rehab Base
(No KE Modifier)

Column III – Wheelchair Base
(KE Modifier)

E1002, E1003, E1004,
E1005, E1006, E1007, E1008, E1010, E1029, E1030, E2310, E2311, E2321,
E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2351,
E2373 KC*, E2374, E2375, E2376, E2377
K0835, K0836, K0837,
K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851,
K0852, K0853, K0854, K0855, K0856, K0857, K0857, K0858, K0859, K0860,
K0861, K0862, K0863, K0864
K0001, K0002, K0003,
K0004, K0005, K0006, K0009, K0830, K0831, K0898, E1050, E1060, E1070,
E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093,
E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172,
E1180, E1190, E1195, E1200, E1220, E1221, E1222, E1223, E1224, E1225,
E1226, E1227, E1228, E1229, E1231, E1232, E1233, E1234, E1235, E1236,
E1237, E1238, E1239, E1240, E1250, E1260, E1270, E1280, E1285, E1290,
E1295

* When billing E2373 KC for use with a Column III wheelchair, use the KE modifier in place of the KC pricing modifier.

IV Pole

When billing an IV pole for use with an enteral code in Column II, do not use the KE modifier. Continue to use the BA modifier. When billing the IV pole for use with a parenteral code in Column III, use the KE modifier in place of the BA modifier.

Column I – IV Pole

Column II – Billed with Enteral Nutrition
(No KE, Only BA Modifier)

Column III – Billed with Parenteral Nutrition
(KE Modifier)

E0776 BA B4149, B4150, B4152, B4153, B4154, B4155 B4164, B4168, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B4216, B4220, B4222, B4224, B5000, B5100, B5200

Canister used with Negative Pressure Wound Therapy Pumps

When billing A7000 for use with a negative pressure wound therapy pump in Column II, do not use the KE modifier. When billing A7000 for use with a respiratory or gastric suction pump code in Column III, use the KE modifier.

Column I – Canister

Column II – Billed with NPWT
(No KE Modifier)

Column III – Billed with Suction Pumps
(KE Modifier)

A7000 E2402 E0600, E2000

Walker Replacement Handgrips and Tips

When billing replacement handgrips and tips for use with a walker code in Column II, do not use the KE modifier. When billing replacement handgrips and tips for use with a cane or crutch code in Column III, use the KE modifier.

Column I – Handgrips and Tips

Column II – Billed with Walkers
(No KE Modifier)

Column III – Billed with Canes or Crutches
(KE Modifier)

A4636, A4637 E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149 E0100, E0105, E0110, E1111, E1112, E0114, E0116, E0117, E0118

For information regarding the KE modifier and the 2009 fee schedule please refer to CR6270.