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Don't Leave Money On The Table: KE Modifier Adjustments From CARES Act For NON-RURAL Areas

Part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act included reimbursement rate changes for certain zip codes and HCPCS codes.

Suppliers that service beneficiaries with a zip code in what is considered a non-rural and noncontiguous areas are receiving the 75/25 blended rate increase. That is 75% of the adjusted rates and 25% of the 2015 unadjusted rates. These rates are retroactive to March 6, 2020 through the remainder of the duration of public health emergency period. A mass adjustment was completed for those dates between March 6 and April 22 (about 51 days). 

Those suppliers in Noridian’s Jurisdiction A or D are now able to submit for a reopening using the KE modifier. Remember the KE modifier was added to the fee schedule for use on items bid under the initial Round 1 of the competitive bid program but used with non-competitive bid base equipment.

Noridian has provided specific instructions for the “Special Project Requests”. 

  • Suppliers must submit a written reopening request by mail, fax, or via Noridian’s portal.
  • Attach a spreadsheet (template attached).
  • Do not put JA and JD claims on same spreadsheet. Each jurisdiction needs their own spreadsheet, regardless of PTANs.
  • Do NOT color code spreadsheet, it will not be accepted.
  • Spreadsheet must include the following:
    1. Supplier NPI and PTAN
    2. Beneficiary full name
    3. Beneficiary Medicare number
    4. DOS
    5. HCPCS codes (list of HCPCS codes affected)
    6. CCN – list each claim number only once on the spreadsheet

For suppliers servicing beneficiaries in either Jurisdiction B or Jurisdiction C, CGS Medicare has not provided instructions for the KE modifier adjustments. We continue to monitor their listserv and will notify VGM members once this instruction has been released.

To read the MLN article discussing the CARES Act rate adjustments, please refer to this link for MLN MM11784.


Ronda Buhrmester                                                         

VGM & Associates                                                                    

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