Fee schedule for repairs and a brief notice of Modifier usage with ABNs.
ABNs modifier use.
1. An ABN for a denial in which the GA modifier is being used has to have been provided prior to delivery of the item.
2. GA means possible Medical necessity denial has been explained to the patient and the reason for the possible denial is written clearly on the ABN form so the patient fully understands.
3. Free upgrade modifier is GL and is used and billed on only one line. EXAMPLE: patient meets criteria for K0001 manual wheelchair but you choose to only provide K0004s (you only keep K0004s in stock) YOU bill with K0001RRKHGLKX modifiers and in the narrative field you state exactly what was given to the patient and why you gave the free upgrade.
4. Billable upgrades you would use two lines. In this instance GA means WANT and GK means NEEDs
Patient WANTS a K0004 manual wheelchair (you keep all types in stock) but patient only meets criteria for a standard manual wheelchair.
Make sure you provide the proper ABN form and explain the patients’ out of pocket expense for both the upgraded K0004 and the standard K0001 BEFORE providing the item.
Billing in first month would be
LINE 1 — K0004RRKHGA
Line 2 K0004RRKHGKKX
This billing continues through out the following months with correct monthly modifiers
Line 1– K0004RRKIGA
Line 2– K0004RRKIGKKX
Third month use KI modifier — 4th through 13th month use the KJ modifier in second position.
The most important thing is fully explaining to the beneficiary or their representative “up front” before delivery their full out of pocket expenses for both the standard and upgraded item.
Click here for Fee Schedule for repairs.
Questions call Peggy Walker at 800-401-3643