Respiratory Assist Devices (RAD) E0470 and E0471 - Billing Reminders

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
March 28th, 2017

Add the KX modifier to all claims for RADs and accessories for the first through third months if all the
coverage criteria have been met.

Add the KX modifier to all claims for the fourth month and thereafter if all the coverage criteria have been met and if the physician signed and dated a statement declaring that the beneficiary is compliantly using and is benefiting from the device.

The signed physician statement must be obtained and kept on file by the supplier for continued coverage beyond three months.

The signed physician statement should not be sent in with the claim but must be available upon request.

When there is an expectation of a medical necessity denial, the GA modifier must be added to the code. These cases apply if a valid Advance Beneficiary Notice (ABN) or GZ modifier has been obtained or if a valid ABN has not been obtained.

Claims for ventilators (E0465, E0466) used for the treatment of conditions described in the RAD LCD will be denied as not reasonable and necessary. 

References:

• References: L11493, A23902 (prior to 10/01/2015); L33800, A52517 (on/after 10/01/2015)