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.