DME Modifiers- AU, AV, AW, KM & KN and List of Medicare Modifiers

Durable medical equipment (DME) modifiers play a crucial role in DME billing and coding. Since we have Medicare grabbing the highest position in the insurance service provider sector, it is ideal that you know about a few of the important CPT and Medicare modifiers before you take a step with your claim/reimbursement.

What are these DME modifiers – AU, AV, AW, KM, & KN and what are they meant for?

There are a number of existing DME modifiers that have been into use for quite a long time now. Now, these modifiers have been recently added to the list of HCPCS in order to identify the DMEPOS supplies that are covered under the relevant category.

What is a modifier and how does it affect your payment?

A modifier can be dedicatedly defined as a change indicator in the service or procedure that has already been performed, without changing the nature or definition of the code. In other terms, it can also be called as alternative codes to previous claims in case any modifiers are newly added to the HCPCS list.

This list has to be kept updated and should be entered rightly in the claim form while submitting; otherwise, it may take a lot of time and effort to process the specific claim. You should place the modifier in the right place while claiming. Misplaced modifiers may not be considered or will not be progressed for reimbursement unless you submit proper documentation supporting the modifier, thus affecting the payment of your claim.

What is the purpose of using a modifier on a Medicare claim?

Depending on the modifiers on a Medicare claim, any missing or additional information required for the claim is submitted and the payment for the code is also determined.

Now let us take a deep look into the newly added codes AU, AV, AW, KM, & KN.

AU-It is used for items furnished in relation to the supply of urological, ostomy, or tracheostomy.

AV– It is used for items furnished in relation to the supply of a prosthetic device, prosthetic, or orthotic.

AW– It is used for items furnished in relation to a surgical dressing.

These three modifiers are applicable to codes A4450, A4452, and sometimes AU for A4217 as well. DMEPOS providers should use these modifiers in case they come across A4450, A4452, or A4217. In the future, it is also possible to get other codes in relation to these new modifiers. Medicare decides its payment for the codes A4217, A4450, and A4452 no matter if these modifiers are specified or unspecified.

KM– It is used for the replacement of facial prosthesis that contains a new impression or moulage.

KN– It is also used for the replacement of facial prosthesis that uses an existing master model.

The codes L8040 and L8047 determine facial prostheses for which the KM and KN modifiers can be reported to the provider in the claim form. Medicare contractors’ base payment is valid only if these modifiers are present in the form and can be used only when the prostheses is replaced.

How to understand the importance of modifiers?

It is not necessary for a provider to approve your claim because it is just covered and the service is reimbursable. Before you provide the modifiers, it is important that you clearly go through the rules of Medicare during claims. It is the provider’s responsibility that before submitting claims should be aware of the Medicare reimbursement program requirements.

Proper guidelines for using modifiers

The following guidelines can get your payments properly for the DMEPOS services you offer. This will help you avoid the possibility of getting claims rejected.

•   Always use valid modifiers.
•   Go through the claim form properly and indicate the valid modifier in the respective column
•   Do not specify any additional information next to modifiers because sometimes system may not be able to read it correctly.
•   Do not give excessive spaces between one modifier and another.
•   Avoid using punctuation in the places where you need to enter modifiers.

Conclusion:

If you require any free consultation on your DEMPOS claims, the 24/7 Medical Billing Services Company offers prompt solutions through an expert’s team. If you are looking for HCC Coding, Medical Billing Audit/Consultation, Insurance Credentialing Consultation, and more, contact the customer support team of 24/7 Medical Billing Services for reliable and high-quality service.