What are the Appropriate Modifiers to Use for the Billing of CTPs?

KX Modifier

The KX modifier is utilized to designate DOCUMENTATION ON FILE. Use this modifier to indicate that specific documentation is contained in the medical record to justify the billed service.

“Requirements specified in the medical policy have been met.”

Check your LCD!

Most require

JW / JC Modifiers

The JC modifier is no longer used to designate how much of the CTP was actually used to apply to the ulcer.

The JW modifier is used to designate how much of the CTP was wasted.

Code product using 2 lines.

     Units of CTP used:  Q code X units 

     Units of CTP discarded: Q code X units - JW modifier

Line 1 + Line 2 = Total CTP product

Example:

A 6 sq. cm. piece of CTP is used to cover a 5 sq. cm. foot ulcer.

Line 1: 15275 (application of skin substitute)

Line 2: Q4160 5 units - KX

Line 3: Q4160 1 unit – JW – KX

JZ Modifier

•      • Effective date July 1, 2023
•      • JW and JZ Modifier Billing Guidelines
  •           ○ JZ Modifier is a HCPCS Level II modifier reported on a claim to attest that no amount of CTP was discarded and is eligible for payment
  •           ○ To submit claims for a waste-required claim, submit two complete claim lines.
    •                ‣ Claim line #1:
    •                ‣ HCPCS Level II code for CTP applied
    •                ‣ No modifier appended
    •                ‣ Number of units of CTP applied
    •                ‣ Calculated submitted price for ONLY the amount of CTP applied
    •                ‣ Claim line #2
    •                ‣ HCPCS Level II code for CTP wasted
    •                ‣ JW modifier appended to HCPCS Level II code to indicate CTP wasted
    •                ‣ Number of units of CTP wasted
    •                ‣ Calculated submitted price for ONLY the amount of CTP wasted
  •           ○ To submit claims for a non-discarded claim, submit one complete claim line.
    •                ‣ HCPCS Level II code for CTP applied
    •                ‣ JZ modifier to indicate no waste of CTP
    •                ‣ Number of units of CTP applied
    •                ‣ Calculated submitted price for the amount of CTP applied

This is my opinion.

Michael G. Warshaw

DPM, CPC

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