US · guidance
CMS Pub. 100-04, ch. 32, § 240
Special Instructions for Services with a Gender/Procedure Conflict
Claims for some services for beneficiaries with transgender, ambiguous genitalia, and
hermaphrodite issues, may inadvertently be denied due to sex related edits unless these
services are billed properly.
The National Uniform Billing Committee (NUBC) has approved condition code 45
(Ambiguous Gender Category) as a result of the increasing number of claims received that are
denied due to sex/diagnosis and sex/procedure edits. This claim level condition code should
be used by institutional providers to identify these unique claims and alerts the fiscal
intermediary that the gender/procedure or gender/diagnosis conflict is not an error allowing
the sex related edits to be by-passed.
The KX modifier (Requirements specified in the medical policy have been met) is now a
multipurpose informational modifier and will also be used identify services for transgender,
ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses.
Physicians and non-physician practitioners should use modifier KX with procedure codes that
are gender specific in the particular cases of transgender, ambiguous genitalia, and
hermaphrodite beneficiaries. Therefore, if a gender/procedure or gender/diagnosis conflict
edit occurs, the KX modifier alerts the MAC that it is not an error and will allow the claim to
continue with normal processing.
History
(Rev. 1877, Issued: 12-18-09, Effective: 04-01-10, Implementation: 04-05-10)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
a2bfdee25faced390d886cd02e023fc7e426e2b48e759c8176df0e108bb1cb23
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