KX Modifier?

Question:

Should the KX modifier be billed on all feminization procedures in the setting of gender dysphoria? For example, feminization rhinoplasty for a trans female patient assigned male at birth.

Answer:

In the context of gender-affirming surgery, the KX modifier should be appended to procedure codes that are gender-specific—particularly when there is a mismatch between the patient’s gender marker and the procedure or diagnosis code. This modifier alerts the payer that the coding is intentional and not an error.

In the example provided—feminization rhinoplasty for a trans female patient—there is typically no conflict between the gender marker and the procedure or diagnosis code. As such, the KX modifier would generally not be necessary.

It’s important to note that modifier KX indicates that “requirements specified in the medical policy have been met.” This modifier is not exclusive to gender-affirming procedures and may be used in other contexts.

In closing, always consult the payer-specific policy and your internal coding compliance guidelines to ensure accurate and compliant use of modifiers.

Thank you for contacting KZA!

*This response is based on the best information available as of 11/20/25.