New Modifiers For Use With Services Related to Gender Dysphoria

November 10, 2016 - To better identify claims associated with the diagnosis of gender dysphoria (and help your practice avoid denied claims), effective Jan. 1, 2017, you should be using the appropriate modifier noted below depending on the type of claim you are submitting:

Provider TypeModifier or Condition Code Definition of Modifier or Condition Code
Professional KX modifier "Requirements Specified in the medical policy have been met."
Institutional KX modifier & "Requirements Specified in the medical policy have been met."
Condition Code 45 "Ambiguous Gender Category"

*Using the proper code allows for appropriate payment of the claim and helps to prevent edits and denied claims.

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