CMS Issues Reminder for Claims with More than Four Modifiers

The January 1 requirement regarding the KE modifier has now caused many DME claims to contain more than four modifiers, says the Centers for Medicare & Medicaid Services (CMS).

As a result, CMS has issues a billing reminder to DME suppliers about how to handle this situation.

The reminder pertains to all four DME MAC jurisdictions.

"When more than four modifiers are required on a claim line, suppliers should append the 99 modifier in the fourth two-digit position," said the Sept. 25 notice from CMS. "If the item requires a pricing modifier NU, RR, or UE along with the KE pricing modifier, the NU, RR or UE modifier should be placed in the first position following the HCPCS code, and the KE modifier should be placed in the second position.

"If the item also requires a capped rental modifier (KH, KI, KJ, KR, MS, BR, BP or BU), it would be placed in the third position followed by any subsequent informational modifiers (RT, LT, RA, RB, GA, etc.). If the item requires a KX modifier, we suggest the KX modifier be placed on the claim line."

The CMS notice added, "However, if the claim line necessitates the use of more than four modifiers, the 99 modifier must be placed in the fourth two-digit position. Suppliers should then list ALL of the modifiers in Item 19 for hard-copy claims or in the NTE segment for electronic claims. The modifiers should be listed first before any other narrative information and should not include any spaces."

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Laurie Watanabe is the editor of Mobility Management. She can be reached at

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