Competitive Bidding: Traveling Beneficiaries

It is not uncommon for a Medicare beneficiary to reside in one location and travel to or temporarily reside in another location. When the patient needs a brace while traveling, there are specific rules in place for both the patient and the supplier when Competitive Bid products and areas are involved.

In this second post in our series on Competitive Bidding, we discuss traveling beneficiaries.

​​​​​​What Does This Mean for You?

When a Medicare Beneficiary lives in one Competitive Bid Area (CBA) and travels to another CBA, there are steps to follow when dispensing and billing a back brace or knee brace to that patient.

1. Determine if the patient’s permanent address, on file with Social Security Administration, is in a CBA. To determine if a beneficiary is in a CBA, go to www.dmecompetitivebid.com, select “Tools” at the top of the page, then select “Find a CBA” and enter the ZIP Code. You may also call 1-800-MEDICARE (1-800-633-4227).
2. If the patient’s permanent address indicates they live in a CBA, then you must be a contracted CB supplier in your area to provide services to the patient. Follow the documentation requirements outlined in the appropriate LCD and obtain corroborating documentation from the patient’s treating physician.
3. When billing the claim, in addition to any required modifiers outlined in the LCD, use the “KT” modifier to indicate the patient is obtaining care outside of their permanent CB. For back braces, you will use only the modifier KT. For knee braces, you will use RT and/or LT, KX, and KT.

Remember, payment amount is the allowable amount for the patient’s permanent address.

For more information, check out the “Traveling Beneficiary” fact sheet, which includes examples, created by CMS.

Next week we will review the fee schedule amounts for competitively bid items.