2025 HCPCS code KD
Modifier KD is used to indicate that a drug or biological was infused through durable medical equipment (DME), such as an implanted infusion pump.
Medical necessity for the use of an implanted infusion pump and the specific drug administered must be clearly documented. This often involves demonstrating that other treatment methods have been unsuccessful or are contraindicated, and that the implanted pump is the most appropriate method for delivering the medication.
The provider is responsible for documenting the medical necessity of the drug administered via the implanted infusion pump, including the specific condition being treated and the appropriateness of using an implanted DME for drug delivery.They are also responsible for proper coding and billing with modifier KD.
In simple words: Modifier KD is used when a medicine is given through a surgically implanted pump.This tells the insurance company that the medicine was given in a special way.
This modifier is appended to drug and biological codes to specify administration through an implanted infusion pump (DME).The pump delivers medication continuously or intermittently, and Medicare covers this administration for specific drugs treating conditions like heart failure, pulmonary arterial hypertension, immune deficiency, diabetes, severe pain, and chemotherapy. Medical documentation must confirm the medical necessity of the drug and its administration via an implanted DME.
Example 1: A patient with severe, chronic pain unresponsive to other treatments receives pain medication through an implanted infusion pump. The code for the narcotic, along with modifier KD, is billed to indicate the method of administration., A patient with type 1 diabetes has an insulin pump implanted for continuous insulin delivery. Modifier KD is appended to the insulin code to specify the use of the DME., A patient with heart failure receives medication through an implanted infusion pump to manage their condition. The appropriate drug code, along with modifier KD, is billed.
Documentation must support the medical necessity of the drug and its administration through the implanted DME. This includes the diagnosis, the rationale for using an implanted pump, type of pump, the drug administered, dosage, and frequency.
- Specialties:Pain Management, Endocrinology, Cardiology, Oncology, various other specialties depending on the drug and condition being treated.
- Place of Service:Inpatient Hospital, Outpatient Hospital, Physician's Office, and other places of service where the implantation and subsequent management of the infusion pump might occur.