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August 11, 2023

How to Choose the Correct Oxygen Modifier

Are your oxygen claims denying due to missing or invalid modifiers? We found recent claim submission errors involving oxygen HCPCS codes with either missing or invalid modifiers.

You must consider these questions when selecting the correct modifier:

What is the date of service on the first month of rental?
Is the beneficiary qualified under oxygen coverage Group I, Group II, or Group III?

We developed the Advanced Modifier Engine (AME) to help you find the correct modifier. The following scenarios address the most common reasons for denial and use of the CR modifier:

Scenario

Instructions

Examples

New Oxygen Rental Period Starting April 1, 2023

New oxygen coverage modifiers became effective April 1, 2023. Use the N1, N2, or N3 modifier when all coverage criteria are met. These are published in the Oxygen LCD.

N1 – Group I oxygen coverage met.
N2 – Group II oxygen coverage met.
N3 – Group III oxygen coverage met.

New claims for oxygen or new 36-month oxygen rental periods with dates of service on or after April 1, 2023, sent with the KX modifier, will reject for invalid modifier.

First Date of Service	HCPCS & Modifiers
04/01/2023	E1390RRN1

Dates of Service April 1, 2023 – May 11, 2023

Use the CR modifier and “COVID-19” narrative in addition to the N1, N2, or N3 modifier.

First Date of Service	HCPCS & Modifiers	Narrative
04/01/2023	E1390RRN1CR	“COVID 19”

When none of the N-modifiers are applicable, you may continue to use the CR modifier and “COVID-19” narrative without an N1, N2, N3, or KX modifier.

First Date of Service	HCPCS & Modifiers	Narrative
04/01/2023	E1390RRCR	“COVID 19”

You may continue to use the CR modifier and “COVID-19” narrative on rental claims for the duration of the 36-month rental period. See “Claim Submission Instruction Post-PHE – Continued Use of Modifier CR and COVID Narrative” for more information.

CR Modifier After May 11, 2023

The COVID-19 Public Health Emergency (PHE) ended on May 11, 2023. The CR modifier and “COVID-19” narrative is not applicable for first claims or new 36-month rental periods starting May 12, 2023. Use the N1, N2, or N3 modifier.

First Date of Service	HCPCS & Modifiers
05/13/2023	E1390RRN1

KX Modifier

The KX modifier is not valid for first oxygen claims or new 36-month rental periods with dates of service beginning April 1, 2023.

You may continue to use the KX modifier for oxygen covered by Medicare prior to April 1, 2023. You may also continue to use the CR modifier and “COVID-19” narrative on rental claims for the duration of the 36-month rental period.

First Date of Service	HCPCS & Modifiers	Narrative
03/01/2023	E1390RRKXCR	“COVID 19”
Second Rental Month
04/01/2023	E1390RRKXCR	“COVID 19”

Coverage Criteria Not Met

Use the GA, GY, or GZ modifier when coverage criteria are not met.

GA	Waiver of liability (expected to deny not reasonable and necessary, Advance Beneficiary Notice (ABN) on file)
GY	Item or service statutorily excluded or does not meet the definition of any Medicare benefit.
GZ	Item or service not reasonable and necessary (expected to deny not reasonable and necessary, no ABN on file)

Claim lines billed without a GA, GY, GZ, KX, N1, N2, or N3 modifier will reject for missing information.

Read coverage information and coding rules here:

Date of Service	HCPCS/Modifiers	Billing Scenario
04/01/2023	E1390RRGA	Medical necessity denial, valid ABN on file
04/01/2023	E1390RRGZ	Medical necessity denial, no ABN on file
04/01/2023	E1390RRGY	Item is statutorily excluded, or does not meet the definition of any Medicare benefit

How to Correct Denied Claims

Oxygen HCPCS codes billed with a missing or invalid modifier will deny as unprocessable. Simply correct the modifier and file a new claim.

Tools & Resources

	Need help finding the correct modifier? Try the Advanced Modifier Engine (AME)

	We collected your questions about changes to the oxygen policy and published a comprehensive list of Oxygen FAQs.

Please let us know if this article was helpful or how we can improve by using the "Feedback" button on the right.

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

How to Choose the Correct Oxygen Modifier

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