CurrentPremera BluecrossPolicy N/A

Modifier KX usage on professional claims

Defines when Premera recognizes Modifier KX on CMS-1500 or 837P professional claims to indicate compliance with a Plan medical policy; applies to Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company, and Premera Blue Cross HMO lines of business and products.

Policy Summary

PayerPremera Bluecross

PolicyModifier KX usage on professional claims

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective DateN/A

Next Review DateJun 12, 2025

Key ActionAppend Modifier KX when Plan medical policy compliance is met and ensure patient records document compliance and are available on request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5Lines of business

annualReview cadence

yesDocumentation required

possibleDenial risk

Modifier KX Coverage Criteria

Modifier KX coverage rules

Covered when ALL of the following are met:

Applies to services submitted on a CMS-1500 paper claim or 837P electronic claim form for the named Premera lines of business and products.

No exceptions specified in this policy.

Coding

ModifierModifier

No codes listed

Provider Submission Requirements

Prior Authorization

Modifier KX submission and documentation requirement

Policy Summary

PayerPremera Bluecross

PolicyModifier KX usage on professional claims

Policy CodePolicy N/A

Change TypeAnnual review — no material changes

Effective DateN/A

Next Review DateJun 12, 2025

Key ActionAppend Modifier KX when Plan medical policy compliance is met and ensure patient records document compliance and are available on request.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Definitions

Modifier KX 14 Definition and documentation expectation

DefinitionModifier KX: appended to a service to indicate that the compliance parameters of a Plan medical policy have been met

Documentation expectationThe patient’s medical records must document compliance and must be available for viewing upon request

Claim forms where recognizedRecognized when submitted on a CMS-1500 paper claim or 837P electronic claim form

Consequence of omissionCodes submitted without Modifier KX may be denied reimbursement per applicable medical policy parameters

Scope of applicabilityApplies to Premera Blue Cross; Premera Blue Cross Blue Shield of Alaska; LifeWise Health Plan of Washington; LifeWise Assurance Company; and Premera Blue Cross HMO lines of business and products

EnforcementViolations may result in increased auditing/monitoring, contractual penalties, corrective action up to termination, or other disciplinary actions at the Plan’s discretion