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How To Use Modifier KL | Description & Billing Guidelines

What Is Modifier KL?

The KL modifier is defined by the CPT manual as: “DMEPOS item delivered via mail.” Effective January 1, 2009, the KL modifier has been changed from an informational modifier to a pricing modifier in the HCPCS file.

Contract suppliers must use the KL modifier on all claims for diabetic supply codes that are furnished via mail order.

Non-contract suppliers that furnish mail-order diabetic supplies to beneficiaries who do not live in CBAs must also continue to use the KL modifier with these codes.

Suppliers that furnish mail-order diabetic supplies that fail to use the HCPCS KL modifier on the claim may be subject to significant penalties.

When To Use A KL Modifier?

The KL modifier will need to be used for all diabetic supply codes except for claims for items that a beneficiary or caregiver picks up in person from a local pharmacy or supplier storefront.

Modifier KL is applicable only for the below-listed HCPCS codes:

  • A4256: Normal, low, and high calibrator solution/chips
  • A4258: Spring-powered device for lancet, each
  • A4259: Lancets, per box of 100

Inappropriate use of a competitive bidding modifier on a competitive bidding claim is in violation of the law and may lead to claims denial and/or other corrective actions.

The use of a competitive bidding modifier does not supersede existing Medicare modifier use requirements for a particular code, but rather should be used in addition, as required.

Return To List Of HCPCS Level II Modifiers

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