K Modifiers

K0

Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.

K1

Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator.

K2

Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator.

K3

Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.

K4

Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete.

KA

Add on option/accessory for wheelchair

KB

Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim

KC

Replacement of special power wheelchair interface

KD

Drug or biological infused through dme

KE

Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment

KF

Item designated by fda as class iii device

KG

Dmepos item subject to dmepos competitive bidding program number 1

KH

Dmepos item, initial claim, purchase or first month rental

KI

Dmepos item, second or third month rental

KJ

Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen

KK

Dmepos item subject to dmepos competitive bidding program number 2

KL

Dmepos item delivered via mail

KM

Replacement of facial prosthesis including new impression/moulage

KN

Replacement of facial prosthesis using previous master model

KO

Single drug unit dose formulation

KP

First drug of a multiple drug unit dose formulation

KQ

Second or subsequent drug of a multiple drug unit dose formulation

KR

Rental item, billing for partial month

KS

Glucose monitor supply for diabetic beneficiary not treated with insulin

KT

Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item

KU

Dmepos item subject to dmepos competitive bidding program number 3

KV

Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service

KW

Dmepos item subject to dmepos competitive bidding program number 4

KX

Requirements specified in the medical policy have been met

KY

Dmepos item subject to dmepos competitive bidding program number 5

KZ

New coverage not implemented by managed care