KX and GA Modifiers

The KX and GA modifiers are available to be turned on in the patient chart on a per case basis. These modifiers are used once the Medicare Therapy Cap has been reached.

  • Using the KX modifier notifies Medicare that the treatment is medically necessary. Attaching the KX modifier to documentation and claim forms will attest that the services billed: are reasonable and medically necessary, have supporting documentation is on file, qualify for therapy cap exception, and requires the skill of a PT/OT/SLP. 
  • Using the GA modifier notifies Medicare that an ABN is on file and non-covered charges by Medicare will be the responsibility of the patient. By adding the GA modifier, Medicare will reject the claim and send the denial. You can then collect the non-covered charges from the patient. 

To learn more about the KX and GA modifiers, read this article. If you still have questions, check out "When to Use the KX Modifer." You may also benefit from watching our webinar on modifiers: Medicare Open Forum.

Enable the KX or GA Modifier

  1. In the patient chart and click Patient Info.  
  2. Navigate to the Cases section. Click the Edit icon for the desired case. 
  3. In the Apply Modifier section, select either "KX" or "GA" to enable the modifier. The modifier will be applied to the applicable CPT codes on future dates of service for the case. Important: If you addend a previous note once the modifier setting has been applied, the modifier will affix to the CPT codes.                 
  4. Click OK and then Save Patient to return to the chart.