Compliance Today, December 2019

According to a recent MLN Connects notice, “A recent Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements.

“In response to this report, CMS clarified manual instructions on the use of the KX modifier to help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage.

Resources for pharmacies:

Pharmacy Billing of Immunosuppressive Drugs MLN Matters Article https://go.cms.gov/33ZDcpI

Clarification of the Billing of Immunosuppressive Drugs MLN Matters Article https://go.cms.gov/32CSNuS

CMS and Its Claims Processing Contractors Issued Conflicting Guidance on the Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims OIG Report” https://bit.ly/2BDPVSI

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