MedicaidBilling CodesMedium impact
Modifier KX and Condition Code 45 on Claims for Services for Transgender, Ambiguous Gender, and Hermaphrodite Patients Effective September 1, 2024
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Sep 1, 2024
We identified it
Jun 20, 2026
Summary
Starting September 1, 2024, providers must add Modifier KX on professional claims or Condition Code 45 on institutional claims when billing sex-specific procedures or diagnoses for transgender, ambiguous gender, or hermaphrodite patients to avoid R16 claim rejections. This applies to all Illinois Medicaid fee-for-service and managed care organization claims.
Action Required
Immediately: Billing team must update claim submission procedures to include Modifier KX on professional claims service lines with sex-specific procedures for transgender, ambiguous gender, or hermaphrodite patients. For institutional claims, add Condition Code 45. Update billing software rules and staff training to identify these patient populations and apply appropriate modifiers. Claims without proper modifiers will receive R16 rejections.