- ModifierDescription
- K0Lower 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.
- K1Lower 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.
- K2Lower 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.
- K3Lower 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.
- K4Lower 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.
- KAAdd on option/accessory for wheelchair
- KBBeneficiary requested upgrade for abn, more than 4 modifiers identified on claim
- KCReplacement of special power wheelchair interface
- KDDrug or biological infused through dme
- KEBid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
- KFItem designated by fda as class iii device
- KGDmepos item subject to dmepos competitive bidding program number 1
- KHDmepos item, initial claim, purchase or first month rental
- KIDmepos item, second or third month rental
- KJDmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
- KKDmepos item subject to dmepos competitive bidding program number 2
- KLDmepos item delivered via mail
- KMReplacement of facial prosthesis including new impression/moulage
- KNReplacement of facial prosthesis using previous master model
- KOSingle drug unit dose formulation
- KPFirst drug of a multiple drug unit dose formulation
- KQSecond or subsequent drug of a multiple drug unit dose formulation
- KRRental item, billing for partial month
- KSGlucose monitor supply for diabetic beneficiary not treated with insulin
- KTBeneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
- KUDmepos item subject to dmepos competitive bidding program number 3
- KVDmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
- KWDmepos item subject to dmepos competitive bidding program number 4
- KXRequirements specified in the medical policy have been met
- KYDmepos item subject to dmepos competitive bidding program number 5
- KZNew coverage not implemented by managed care