“If orthotics are not covered by Medicare, if the KX modifier is appended to L3000-RT and L3000-LT, I am getting paid. Is it wrong to use the KX modifier to get paid for orthotics?”
- 1. Orthotics are statutorily NOT COVERED by any Medicare Administrative Carrier
- 2. So why are orthotics targeted by CMS to be audited?
- 3. Providers, either inadvertently, by their billers/billing company, or by design have found an inappropriate method to bill for orthotics by bypassing the rules and regulations
- • The orthotics are billed to the respective Durable Medical Equipment Carrier (DMERC) inappropriately using the KX modifier
- • The KX Modifier is defined as the following: Documentation on File
Use this Medicare modifier to indicate that specific documentation is contained in the medical record to justify the billed service. This modifier is used on all line items for claims that are submitted to the DMERC.
- 4. When orthotics are inappropriately billed to the DME Regional Carrier (ie. L3000 KX,RT; L3000 KX, LT), the KX modifier allows an automatic bypass and allows payment of this code
- 5. When an audit occurs, the KX modifier states that the necessary documentation is on file to justify the billed service. Since the service is statutorily NOT covered, there is no supporting documentation on file, thus how does one justify the billing for orthotics? You can’t.
This is my opinion.
Michael G. Warshaw
THE 2023 PODIATRY CODING MANUAL IS NOW AVAILABLE in either Book or Flashdrive formats. It has been completely updated including the 2023 E/M coding changes. Many offices across the country consider this to be their “Bible” when it comes to coding, billing and documentation. The price is still only $125 including shipping! To purchase, access the website drmikethecoder.com.
No credit card? No problem! Just send a check for $125 to the following address:
Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, Florida 32757