CMS Pub. 100-04, ch. 36, § 50.14

Equipment

(Rev. 2231, Issued: 05-27-11, Effective: 08-28-11, Implementation: 08-28-11)

Non-contract grandfathered suppliers must use the KY modifier on claims for CBA-residing

beneficiaries with dates of service on or after January 1, 2011, for purchased, covered

accessories or supplies furnished for use with rented grandfathered equipment. The following

HCPCS codes are the codes for which use of the KY modifier is authorized:

• Continuous Positive Airway Pressure Devices, Respiratory Assistive Devices, and

Related Supplies and Accessories - A4604, A7030, A7031, A7032, A7033, A7034,

A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, and E0562

• Hospital Beds and Related Accessories - E0271, E0272, E0280, and E0310

• Walkers and Related Accessories - E0154, E0156, E0157 and E0158

Grandfathered suppliers that submit claims for the payment of the aforementioned purchased

accessories and supplies for use with grandfathered equipment should submit the applicable

single payment amount for the accessory or supply as their submitted charge on the claim. Non-contract grandfathered suppliers should be aware that purchase claims submitted for these codes

without the KY modifier will be denied. In addition, claims submitted with the KY modifier for

HCPCS codes other than those listed above will be denied.

After the rental payment cap for the grandfathered equipment is reached, the beneficiary must

obtain replacement supplies and accessories from a contract supplier. The supplier of the

grandfathered equipment is no longer permitted to furnish the supplies and accessories once the

rental payment cap is reached.