Negative Pressure Wound Therapy Billing Modifiers

KX, GA, and GZ Modifiers:

Suppliers must add a KX modifier to a code only if all of the criteria in the "Coverage Indications, Limitations and/or Medical Necessity" section of the related LCD have been met.

The KX modifier must not be used with a NPWT pump and supplies for wounds if:

  1. The pump has been used to treat a single wound and the claim is for the fifth or subsequent month's rental, or
  2. The pump has been used to treat more than one wound and the claim is for the fifth or subsequent month's rental after therapy has begun on the most recently treated wound. In this situation, the KX modifier may be billed for more than four total months of rental.

In all of the situations above describing use of the KX modifier, if all of the coverage criteria have not been met, the GA or GZ modifier must be added to a claim line for the Negative Pressure Wound Therapy (NPWT) pump and supplies. When there is an expectation of a reasonable and necessary denial, suppliers must enter the GA modifier on the claim line if they have obtained a properly executed Advance Beneficiary Notice (ABN) or the GZ modifier if they have not obtained a valid ABN.

Claim lines billed without a KX, GA, or GZ modifier will be rejected as missing information.

Last Updated Jul 10 , 2024