Requesting Reopenings for Ankle Foot Orthosis/Knee-Ankle Foot Orthosis Denials
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Requesting Reopenings for Ankle Foot Orthosis/Knee-Ankle Foot Orthosis Denials

Effective June 1, 2009, the AFO/KAFO local coverage determination ( LCD ) was revised to require the use of a KX modifier to the AFO/KAFO base and addition codes if all of the coverage criteria in the "Indications and Limitations of Coverage and or Medical Necessity” section of the policy are met.  CIGNA Government Services has noted a significant increase in call volume for Reopenings from suppliers failing to add the KX modifier.

If your claim was denied because you forgot to add the KX modifier to a claim line(s), a Reopening may be requested.  For telephone Reopenings, up to 5 claim issues may be resolved during one call.  If you have more than 5 claim issues, you must submit the reopening request by fax.  In the fax request, it is helpful to include the Reopenings Request form with a listing of the appropriate information to process the claim adjustment.  A copy of the Reopening Request form can be found at:  The Reopenings fax line number is 615.782.4649.

In addition to the KX modifier, the right (RT) and left (LT) modifiers must be used with orthosis base codes, additions, and replacement parts.  When the same code for bilateral items (left and right) is billed on the same date of service, bill both items on the same claim line using the LTRT modifiers and 2 units of service.  Claims rejected for missing RT or LT modifiers may be corrected and resubmitted.

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