KE Modifier Eliminated

Posted on in Billing/Reimbursement

The KE modifier has been eliminated effective July 1, 2016, according to an MLN Matters release dated June 23.

When the Medicare beneficiary resides in a competitive bid (CB) area and a CB accessory is provided on a non-bid, manual wheelchair base (K0005, E1161), the KY modifier ONLY should be used to allow the system to use the 2016 competitive bid-adjusted fee schedule rather than the single-payment amount (SPA). The 2016 competitive bid-adjusted fee schedule is higher than the SPA.

When the beneficiary does NOT reside in a competitive bid area, the allowable for bid accessories will be based on the 2016 competitive bid-adjusted fee schedule.

For your reference, please see the MLN Matters Number MM8864 and MLN Matters Number MM9642.

If you have any questions, feel free to reach out to me.

Several other major changes have been implemented this month that greatly impact billing and reimbursement of wheelchair accessories. I will explore those changes in a webinar Tuesday, July 19. Please click here for more information and to register for the webinar.

Dan Fedor
Reimbursement Specialist
P: 844-794-8459
F: 844-307-5729
[email protected]