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 Anti-emetic Drugs (Replacement for Intravenous Anti-emetics)

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 Advanced 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 LCD's, Policy Articles, and the JB Supplier Manual.

Wheelchair Seating

Oral Appliances for Obstructive Sleep Apnea

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