Well, the answer is no. Since you are reporting the global service, Medicare does not require you to append modifier KX (Requirements specified in the medical policy have been met).
In transmittal 2096, CR 7125, CMS published the guidelines on coding these services (including a helpful chart showing which tracer codes pair with which PET codes).
TC/global: When you report a global or technical only claim with A9580 (Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries) and an NaF PET service to inform the initial treatment strategy or subsequent treatment strategy for bone metastasis, the transmittal instructs carriers to process claims that cover all of the following (apart from A9580).
One of these modifiers:
modifier Q0 (Investigational clinical service provided in a clinical research study).
Professional component (PC): When you use modifier 26 (professional component) and modifier KX on your PET oncologic claim to inform the initial treatment strategy or subsequent treatment strategy for bone metastasis, the transmittal instructs carriers to process claims that include all of the same items in the bullet list mentioned.
The difference: Code A9580 belongs only on global and technical claims. Carriers will reject professional claims for A9580 as the assumption is that the facility (the entity providing the technical part of the service) bears the cost of the A9580 agent and should be paid for it.
The presence of modifier KX on the professional claim shows contractors they should process the service as PET NaF-18 rather than PET with FDG.
Professional component (PC): When you use modifier 26 (professional component) and modifier KX on your PET oncologic claim to inform the initial treatment strategy or subsequent treatment strategy for bone metastasis, the transmittal instructs carriers to process claims that include all of the same items in the bullet list mentioned.
The difference: Code A9580 belongs only on global and technical claims. Carriers will reject professional claims for A9580 as the assumption is that the facility (the entity providing the technical part of the service) bears the cost of the A9580 agent and should be paid for it.
The presence of modifier KX on the professional claim shows contractors they should process the service as PET NaF-18 rather than PET with FDG.
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