January 16, 2018
KX, GA, GY, and GZ Modifier Reminders
The KX modifier is required for these policies:
| Ankle-Foot/Knee-Ankle-Foot Orthosis | Orthopedic Footwear |
| Automatic External Defibrillators | Patient Lifts |
| Cervical Traction Devices | Positive Airway Pressure Devices |
| Commodes | Power Mobility Devices |
| External Infusion Pumps | Pressure Reducing Support Surfaces |
| Glucose Monitors | Refractive Lenses |
| High Frequency Chest Wall Oscillation Devices | Respiratory Assist Devices |
| Hospital Beds | Speech Generating Devices |
| Immunosuppressive Drugs | Therapeutic Shoes for Persons with Diabetes |
| Knee Orthoses | Transcutaneous Electrical Nerve Stimulators (TENS) |
| Manual Wheelchair Bases | Urological Supplies |
| Nebulizers | Walkers |
| Negative Pressure Wound Therapy Devices | Wheelchair Options and Accessories |
| Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) | Wheelchair Seating |
| Oral Appliances for Obstructive Sleep Apnea |
The KX modifier indicates that all medical policy and documentation requirements have been met and that the billed item is reasonable and necessary. Review the specific LCD and policy article to determine the medical policy and documentation requirements.
All of the listed policies, with the exception of the Glucose Monitor LCD, require that the GA, GY, or GZ modifier be added to the HCPCS when the KX modifier requirements have not been met. Claims submitted for these policies without the KX, GA, GY, or GZ modifiers will be rejected and must be resubmitted. These modifiers cannot be added or changed through claim reopenings.
Read the Glucose Monitors policy for more information about the modifiers required for Glucose supplies.
Add the GA, GY, or GZ modifier based on the reason the KX modifier cannot be added.
The GA modifier is added to claims with a properly executed Advance Beneficiary Notice (ABN) in the file.
The GY modifier is added to claims in which the item or service is statutorily excluded, does not meet the definition of any Medicare benefit, or -for non-Medicare Insurers- is not a contract benefit.
The GZ modifier is added to claims in which the item or service is expected to be denied as not reasonable or necessary and there is not a properly executed ABN in the file.
For more information, refer to the LCDs, Policy Articles, and the JC Supplier Manual.
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