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

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). 

Both DME MAC contractors are accepting the reopening requests. Noridian started accepting the special reopening requests at the end of November. The CGS contractor just started accepting the reopening requests. 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.

For suppliers in JA or JD, 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 here)
  • 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 JB or JC CGS Medicare has released instruction that is vague. The article can be read by clicking here. A recommend template is attached for JB and JC suppliers.

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



Ronda Buhrmester                                                         

VGM & Associates                                                                     

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