Updates to Oxygen Modifiers for Claims

WASHINGTON, D.C. (May 14, 2018)—Effective August 1, 2018, the Centers for Medicare & Medicaid Services (CMS) will require suppliers to use KX, GA, GY and GZ modifiers on oxygen claims. The KX modifier will indicate when payment criteria is met, and the GA, GY and GZ modifiers provide more information for oxygen claims that do not meet payment criteria.

• KX—Requirements specified in the medical policy have been met
• GA—Waiver of liability (expected to be denied as not reasonable and necessary, 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 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. AAHomecare has been requesting this change for many years and is pleased to see the concerns have been addressed.

The modifiers must be included on all oxygen claims with a date of service on or after August 1, 2018. Claims without one of the four modifiers will be denied. You can find the Oxygen and Oxygen Equipment LCD here and Policy Article here.

Visit aahomecare.org for more information.