CMS Releases New Oxygen Claim Modifiers

After years of negotiating, AAHomecare convinces CMS to address need for new modifiers.

CMS has released new KX, GA, GY, and GZ modifiers for oxygen claims, which it will require providers to start using on oxygen claims with a date of service on or after Aug. 1. Claims without one of the four modifiers will be denied.

The KX modifier will indicate when payment criteria is met, and the GA, GY, and GZ modifiers provide additional information for oxygen claims that do not meet payment criteria. Specifically, the modifiers indicate the following:

  • KX - The requirements specified in the medical policy have been met.
  • GA - Waiver of liability (expected to be denied as not reasonable and necessary, with an 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 be denied as not reasonable and necessary, no ABN on file,

The American Association for Homecare released a statement that it had been requesting the change for many years, and noted that It was “pleased to see our concerns have been addressed.”

“The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn’t qualify and get an accurate PR (patient responsibility) denial,” the statement read. “… We thank CMS and DME MACs for this important policy change.”

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About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.


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