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August 4, 2026

Missing Modifiers on Nebulizer Claims (including Dispensing Fees) – Reopening Requests Ending September 1

We updated the process for claims missing the KX, GA, or GZ modifier on nebulizer drugs, dispensing fees, supplies, and other related items.

Starting September 1, 2026, we will stop accepting reopening requests for Scenario 2. You must submit a redetermination request instead. We must receive all reopening requests for this issue by August 31, 2026.

Scenario 2: Suppliers billed the KX, GA, or GZ modifier on the drug and supplies but not on the dispensing fee. Our system split the claim, rejected the dispensing fee with CO-4, and processed the rest of the claim correctly.

Please see the Rejections Due to Missing Modifiers on Nebulizer Claims (including Dispensing Fees) article for more information.

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