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DME

Shade Posted Fri 14th of November, 2014 10:42:56 AM

WHAT OTHER MODIFIER DO I USE WITH RT OR LT ON THE DME EQUIPMENT. MEDICARE IS REQUESTING AN ADDITIONAL MODIFIER WITH THE REGULAR RT/LT. PLEASE HELP. THANK YOU.

SuperCoder Answered Mon 17th of November, 2014 03:03:38 AM

There are four important modifiers KX, GA, GZ and GY that you may append with DME as appropriate:

Modifier KX- Usage of the KX modifier identifies that the requirements identified in the medical policy have been met. Documentation is essential to support that the item is reasonable and necessary and that the specific coverage criteria specified in each policy have been met. The KX modifier has differing requirements for usage depending on the specific Local Coverage Determination (LCD); suppliers should review the LCDs carefully to understand the documentation requirements and the proper use
of the KX modifier for each policy.

Modifier -GA. The -GA modifier is used for services a provider believes will be denied on medical-necessity grounds (not reasonable or necessary) when an advance beneficiary notice (ABN) has been obtained or the patient's refusal to sign the ABN has been properly witnessed in the case of an assigned claim. If Medicare denies the claim, the beneficiary is wholly liable to pay for the services. However, if the provider does not bill using modifier -GA, the beneficiary does not have to pay for the service.

Modifier -GZ. Providers should use the -GZ modifier on unassigned claims for all physician services when the patient has refused to sign an ABN for a provided service. If the claim is denied, the beneficiary is generally not considered liable, but the provider may be able to collect for the service if it is found not liable for an unassigned claim. In such a case, the physician would have to prove that he or she had no way of knowing a service was not medically necessary and, therefore, would be denied. Reimbursement experts say this is difficult to prove. Providers are free not to use the -GZ modifier, but its use helps greatly reduce risks of fraud and abuse allegations.

Modifier -GY. The -GY modifier is used to denote statutorily excluded services, such as routine physical examinations, preventive health counseling and lab tests in the absence of signs and symptoms. Providers do not collect an ABN in such situations. Medicare often automatically denies claims that contain modifier -GY, which expedites the process for providers that require a denial to bill a secondary insurer for the service.

Also, there are two modifiers NU and RR to be used with DME that can be either rented or purchased. RR stands for Rental. NU stands for Purchase of new equipment.

Thanks !!

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