Ambiguous Gender Specific Coding, TR 53014

The following information is being updated in MIHMS to ensure appropriate processing of claims when there is a discrepancy with the diagnosis codes, or CPT/HCPC codes, and a MaineCare member’s gender. UB-04 – Use condition code 45 (Ambiguous Gender Category) to identify services that are gender specific (i.e., services that are considered female or male only).  This condition code should only be used on claims relating to transgender, ambiguous genitalia, or hermaphrodite issues. CMS-1500 – KX modifier should be used to identify services that are gender specific (i.e., services that are considered female or male only).  This modifier should only be used on claims relating to transgender, ambiguous genitalia, or hermaphrodite issues.

Source: https://content.govdelivery.com/accounts/MEHHS/bulletins/15b1b05