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.

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