Modifier KX – Requirements specified in the medical policy have been met
Defines when Premera recognizes Modifier KX on professional (CMS-1500/837P) claims to indicate that medical policy compliance parameters have been met; applies to Premera Blue Cross and affiliated lines of business.
No material clinical or coverage changes in this revision.
KX Modifier Coverage Criteria
KX modifier coverage criteria
Covered when ALL of the following are met:
ALL of the following
- Modifier KX must be appended to indicate compliance with Plan medical policy for the submitted service
- Patient medical records must document the compliance and be available for viewing upon request
- Codes submitted without modifier KX may be denied reimbursement per applicable medical policy parameters
- Applies to professional services billed on CMS-1500 or 837P and to Premera Blue Cross, Premera BCBS of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company, and Premera Blue Cross HMO lines of business
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