| K0 |
Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. |
| K1 |
Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator. |
| K2 |
Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator. |
| K3 |
Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. |
| K4 |
Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete. |
| KA |
Add on option/accessory for wheelchair |
| KB |
Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim |
| KC |
Replacement of special power wheelchair interface |
| KD |
Drug or biological infused through dme |
| KE |
Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment |
| KF |
Item designated by fda as class iii device |
| KG |
Dmepos item subject to dmepos competitive bidding program number 1 |
| KH |
Dmepos item, initial claim, purchase or first month rental |
| KI |
Dmepos item, second or third month rental |
| KJ |
Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen |
| KK |
Dmepos item subject to dmepos competitive bidding program number 2 |
| KL |
Dmepos item delivered via mail |
| KM |
Replacement of facial prosthesis including new impression/moulage |
| KN |
Replacement of facial prosthesis using previous master model |
| KO |
Single drug unit dose formulation |
| KP |
First drug of a multiple drug unit dose formulation |
| KQ |
Second or subsequent drug of a multiple drug unit dose formulation |
| KR |
Rental item, billing for partial month |
| KS |
Glucose monitor supply for diabetic beneficiary not treated with insulin |
| KT |
Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item |
| KU |
Dmepos item subject to dmepos competitive bidding program number 3 |
| KV |
Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service |
| KW |
Dmepos item subject to dmepos competitive bidding program number 4 |
| KX |
Requirements specified in the medical policy have been met |
| KY |
Dmepos item subject to dmepos competitive bidding program number 5 |
| KZ |
New coverage not implemented by managed care |