Article Detail - JA DME

The following EIP policy modifiers are effective March 1, 2023:
For dates of service on or after January 1, 2023

KX: Coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity.

GA: Item or service is expected to be denied as not medically necessary and an ABN has been properly executed.

GZ: Item or service expected to be denied as not reasonable or necessary (items are automatically denied and not subject to complex medical review).

Previously, the External Infusion Pumps LCD-related Policy Article (A52507) only required the use of the KX, GA, or GZ modifier for insulin and insulin infusion pumps (J1817 and E0784). Claims for external infusion pumps, drugs, and supplies billed without a KX, GA, or GZ modifier, with a date of receipt on or after March 1, 2023 (and a "from" date of service on or after January 1, 2023), will be rejected for missing information. Claims for infusion drugs not administered via an infusion pump must continue to be billed with a GY modifier. These changes are detailed at the path here Noridian Medicare Home page > Policies > Medical Director Articles > 2023 > KX Modifier Use for External Infusion Pumps

The following EIP policy modifiers are effective for the April 1, 2023:
For dates of service (DOS) on or after May 1, 2023

JK: One-month supply or less of drug/biological.

JL: Three-month supply of drug/biological.

These changes are based on Change Request 13014 and more information can be found Billing Medicare Part B for Insulin with New Limits on Monthly Coinsurance - Fact Sheet MLN4443820

The following EIP policy modifier is effective July 1, 2023:
For dates of service on or after January 1, 2023

JZ: Drugs from single-dose containers that are separately payable under Medicare Part B when there are no discarded amounts.

Note: Additional clarification is provided below in the frequently asked questions on use of the JW modifier (effective January 1, 2017). JW modifier: Drugs from single-dose containers that are separately payable under Medicare Part B when there are discarded amounts.

These changes are detailed in Article - Billing and Coding: JW and JZ Modifier Billing Guidelines and Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions