What is the purchase modifier for DME?
UE — USED DURABLE MEDICAL EQUIPMENT PURCHASE. This modifier is used for used DME items that are purchased. When using the UE modifier, you are indicating you have furnished the beneficiary with a used piece of equipment.
What is the Ke modifier?
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, and it must be appended to the. accessory code if it is billed with a non-competitively bid base. item.Apr 1, 2009
What is KU modifier?
The KU modifier is used to receive the unadjusted fee schedule amount and was implemented for a variety of wheelchair accessories and seat back cushions used with complex rehabilitative manual wheelchairs and certain manual wheelchairs.
What is CRT in billing?
Complex Rehabilitation Technology (CRT) Billing Guide.Jul 1, 2019
When should KX modifier be used?
The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.
What does modifier KF mean?
Modifier KF is a pricing modifier. The HCPCS codes for DME designated as class III devices by the FDA are identified on the DMEPOS fee schedule by presence of the KF modifier.
What does RB modifier mean?
RB – Replacement of a part of DME furnished as part of a repair. As previously instructed, the new RA modifier is used on DMEPOS claims to denote instances where an item is furnished as a replacement for the same item which has been lost, stolen or irreparably damaged.Oct 28, 2009
How often does the CRT agency update fees?
The agency sets, evaluates, and updates the maximum allowable fees for CRT and related services at least once yearly using available published information including, but not limited to, the following:
When did Apple Health start a managed care program?
Beginning April 1, 2016, Washington Apple Health (Medicaid) implemented a new managed care enrollment policy placing clients into an agency-contracted MCO the same month they are determined eligible for managed care as a new or renewing client. This policy eliminates a person being placed temporarily in fee-for-service while they are waiting to be enrolled in an MCO or reconnected with a prior MCO.
What is DSHS in WA?
The Department of Social and Health Services (DSHS) manages the contracts for behavioral health (mental health and substance use disorder (SUD)) services for nine of the Regional Service Areas (RSA) in the state , excluding Clark and Skamania counties in the Southwest Washington (SW WA) Region. BHOs replaced the Regional Support Networks (RSNs). Inpatient mental health services continue to be provided as described in the inpatient section of
When a provider delivers an item directly to the client or the client's authorized representative, must the provider furnish the
When a provider delivers an item directly to the client or the client's authorized representative, the provider must furnish the proof of delivery when the agency requests that information. All of the following apply:
Does BHO provide behavioral health services?
The Behavioral Health Organization (BHO) will not provide behavioral health services in these counties.
Is there a BHO in Clark County?
Beginning on April 1, 2016, there is not a BHO in Clark and Skamania counties. Providers and clients must call the agency-contracted MCO for questions, or call Beacon Health Options for questions related to a person who is not eligible for or enrolled in Medicaid.
Do you need a prior authorization for CRT?
Yes. The agency requires complex rehabilitation technology (CRT) providers to obtain prior authorization (PA) for CRT products and related services and deliver the CRT product or related service to the client before billing the agency.
What is Medicare Administrative Contractor?
The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.
Does the revision date apply to red italicized material?
Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.
The issue
The Centers for Medicare & Medicaid Services (CMS) groups CRT accessories and standard wheelchair accessories under a single HCPCS code, creating access issues under the competitive bidding program.
Background
Complex rehab power and manual wheelchairs and related accessories serve a small population of people with significant disabilities such as ALS, cerebral palsy, multiple sclerosis, muscular dystrophy, spinal cord injury and traumatic brain injury.
Legislation
The Protecting Access to Wheelchairs Act, HR 2293, sponsored by U.S. Reps. John Larson (D-Conn.) and Lee Zeldon (R-N.Y.), and S 1223, sponsored by U.S. Sens. Bob Casey (D-Penn.) and Rob Portman (R-Ohio), have been introduced to protect access to complex rehab technology for Medicare beneficiaries.
What happens next?
Advocates are also watching HR 2408, The Ensuring Access to Quality Complex Rehabilitation Technology Act, a bill to create a separate benefit category for CRT. This would protect the technology from the competitive bidding program and allow further innovation in the space.
Advocacy Groups to Watch
These advocacy groups are working together to bring changes to the complex rehab benefit: