Pharmacy Question for the Week of January 22, 2018

Pharmacy Compliance Question of the Week

Question:

When should pharmacies use the KX modifier?

Answer:

Pharmacies billing Durable Medical Equipment Medicare Administrative Contractors (DME MACs) for immunosuppressive drugs provided to Medicare beneficiaries who received an organ transplant that was paid for by Medicare may use the KX modifier. Provider-information memo MM10235 explains the appropriate process for billing Medicare for immunosuppressive drugs using this modifier. It can be found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10235.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.