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Sunday, January 11, 2009

New KE Modifier for Complex Rehab

By Patrick Boardman
J and R Medical Houston Texas

Effective January 1st, 2009 the new KE modifier was put into place by CMS. The purpose of the modifier is to differentiate between items that were under competitive bidding and subject to the 9.5% reduction, and items that weren't. Here is the CMS definition:

"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."

An example of the proper use of the KE modifier would be as follows:

K0040 Angle Adjustable Footplates

Scenario 1: Used with a HCPC code of K0004 Manual Wheelchair. Since the manual chair was not part of competitive bidding, the KE modifier would be used to ensure the 9.5% reduction is NOT applied.

Scenario 2: Used with a HCPC code K0856 Power Wheelchair. Since power chairs were under competitive bidding, a KE modifier cannot be used and you will see a 9.5% reduction in the K0040 allowable.

It is important to note that claims should not be filed using the KE modifier for any item that was under Round 1 of competitive bidding.

If anyone has any questions, feel free to contact me. We encourage networking with our peers.

Patrick Boardman
J and R Medical, Houston, Texas

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