Upcoming Changes to the Orthopedic Shoe Policy

Beginning October 1 each claim line for orthopedic shoes must include the KX or the GY modifier. If the items you are providing meet the coverage criteria set forth in the policy, each claim line would include a KX modifier. If an item does not meet the coverage criteria or is a non-covered item (i.e. shoes not attached to a brace) the claim line must include the GY modifier and this claim line will be denied. Therefore, each shoe, insert or modification must include either the KX or the GY modifier. If a claim line doesn't include a modifier, then that line will be rejected and you will have to resubmit that claim line with the appropriate modifier.