KMAP BULLETIN: E/M Modifier 25 Use with KBH Vision Code 99173

Date: 03/20/24

KMAP GENERAL BULLETIN 24032 (PDF)

Effective with dates of service on and after April 1, 2022, modifier 25 can be billed with a Kan Be Healthy (KBH) Evaluation and Management (E/M) code when code 99173 is billed for the same KBH visit. This will allow code 99173 to not deny for payment due to content of service to the preventive office visit. Providers will need to rebill any previously denied claims.

Note: The effective date of the policy is April 1, 2022. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.

For the changes resulting from this provider bulletin, view the updated Vision Feefor-Service Provider Manual, Section 8400, page 8-3.