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

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

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

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

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  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
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  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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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 LCDExternal Website.

  • 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

AME

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

 

 

Questions

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.

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