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Family PACT Update: KX Modifier Facilitates Claims for Transgender Services

July 26, 2017

An article published in the July 2017 Medi-Cal Update titled KX Modifier Facilitates Claims for Transgender Services informed providers that, effective for dates of service on or after August 1, 2017, modifier KX (requirements specified in the medical policy have been met) may be used to facilitate claim processing in instances where the patient's gender conflicts with the billed procedure code. The patient's medical record must support medical necessity for the procedure.

Providers may already override a gender conflict with an approved Treatment Authorization Request (TAR) when the gender on the claim conflicts with the billed procedure code. Use of modifier KX introduces an alternative method to facilitate claims processing without requiring an approved TAR. The use of modifier KX will not override other policy requirements for an approved TAR.

This policy also applies to the Family Planning, Access, Care and Treatment (Family PACT) Program. Updated Family PACT manual pages will be released in a future Family PACT Update bulletin.