What KODEx does not do

It is a reference, not an answer

KODEx collects what public bodies have published about codes, policies and payment, records where each statement came from and when it was last checked, and shows you both. That is the whole of what it does.

It does not decide, and is not built to decide:

• whether a service is payable
• whether a payer covers it, for this patient, on this date
• whether two codes may be billed together
• whether documentation supports the level billed
• whether a service was medically necessary
• what to do about a denial

Those are judgements about a specific claim, made by a person who can see the record. Nothing here replaces that person, and no output should be read as though it had.

Not professional advice

Nothing in KODEx is legal, medical, coding, billing, tax or compliance advice. It is not a substitute for a payer’s own published policy, your provider agreement, your compliance programme, or a qualified professional. Where this application and a payer’s own document disagree, the payer’s document governs — and we give you the link so you can check.

Verify before you act

Every fact carries the document it came from and the date it was last checked. Those are not decoration. Before you rely on something here for a claim, an appeal or an audit response, open the source and read it. If a statement has no source shown, do not rely on it.

Published data goes out of date. Publishers issue corrections, quarterly files supersede one another, and a determination can be retired between one release and the next. The verified date tells you how current a fact is; keeping a claim consistent with what is current is your responsibility, not the application’s.

Licensed code sets are not included

CPT® descriptors are licensed by the American Medical Association, CDT® by the American Dental Association, and the complete CARC and RARC lists by X12. KODEx does not hold any of them. Code numbers appear as identifiers, and where a public CMS document mentions one, we link to that document. If you need the descriptors, you need a licence from the body that owns them. The pages that touch those code sets say so where they say nothing else.

Do not put patient information into it

KODEx is not designed for protected health information and is not offered as a HIPAA business associate. Do not type patient names, dates of birth, member numbers, claim numbers or any other identifying detail into the search box, into a saved folder, or into anything else here. Search text is stored so you can see your own history; treat it as though it were a shared notebook.

No guarantee of accuracy

We take real care: data comes from publishers directly rather than from intermediaries, nothing is paraphrased into a claim the source does not make, and a blank says why it is blank instead of going quiet. None of that amounts to a warranty. Files are misread, publishers change formats without notice, and a parser that has been right ten thousand times can be wrong on the row in front of you. The terms of service set out the legal position; this page sets out the honest one.