Question:

Is it appropriate for a pharmacy to use modifier KX when billing DME MACs for immunosuppressive drugs provided to Medicare beneficiaries who received an organ transplant that was paid for by Medicare?

Answer:

For the appropriate process for billing Medicare for certain claims for immunosuppressive drugs using the KX modifier, go to Medicare Claims Processing Manual, Chapter 17, Section 80.3 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf. Information about this also is available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10235.pdf.

According to the Centers for Medicare & Medicaid Services, this information is especially important for pharmacies as the Health and Human Services Office of the Inspector General (OIG) recently determined that they did not comply with parts of this policy on a significant percentage of related claims.

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