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May 2020

Bypass the manual review requirement for medically necessary insulin pumps

Effective March 1, 2020, health care providers must append the KX and TW modifiers to avoid the manual review process for a medically necessary replacement insulin pump.

To avoid the manual review process, all the following must apply:

  • Insulin pump malfunctioned
  • Manufacturer’s warranty has expired
  • Blue Cross Blue Shield of Michigan’s five-year reasonable useful lifetime, or RUL, hasn’t been reached

By appending the KX and TW modifiers, you are certifying that the member’s insulin pump has malfunctioned after the manufacturer’s warranty period but before the five-year RUL and that the member meets Blue Cross medical criteria for an insulin pump.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.
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