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DME KX Modifier Question


I bill for a piece of of DME that requires a KX modifier.  It is a capped rental.  When we pay the first month of rental we have all required documentation and the patient does meet the criteria for the first month.  After that, we do not get current clinicals each month to be sure that the patient is still meeting the medical criteria.  We are told that as long the CMN states up to 9 months that we are safe.  I think it is still our obligation to be sure that they still meet criteria each month by getting new and updated clinicals.  Any thoughts on this????  Help!!!  Thanks

Your best bet is to call your Medicare DME carrier and ask them.  It is better to be safe than sorry.  It may be correct that if the CMN states 9 months that you don't need monthly updates.  There are some pieces of DME that 1 RX on file for an extended period of time is allowed, so it is possible.  Best to check though.



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