This applies to QUEST Integration, Medicare Advantage, and Commercial Plans effective January 1, 2017.
Modifier Code KX - Requirements specified in the medical policy have been met
Modifier KX is a multipurpose, informational modifier that can be used to identify services for transgender, ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses. Physicians and non-physician practitioners should use modifier KX with procedure codes or diagnosis codes that are gender specific in the particular cases of transgender, ambiguous genitalia, and hermaphrodite beneficiaries. Modifier KX should be billed on the claim line with the gender/procedure or gender/diagnosis conflict.
Condition Code 45 – Ambiguous Gender Category
Condition code 45 indicates that the claim is for a patient with ambiguous gender characteristics. This claim level condition code should be used by institutional providers to identify these unique claims to alert HMSA that the gender/procedure or gender/diagnosis conflict is not an error allowing the sex related edits to be by-passed.