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March 26, 2026

Claims Rejected for Missing KG Modifier

CGS has noticed a high volume of claims for patients who live in former competitive bid areas (CBAs) being rejected for a missing KG modifier.

The KG modifier is used for pricing. It tells Medicare that certain accessories are being billed along with a base item that used to be part of the Competitive Bidding Program.

You must add the KG modifier only in former CBAs and only for the specific accessory-and-base-item pairs listed below:

Policy Group Must Append the KG Modifier to: When Used with the Following Base Equipment:
Enteral Nutrition E0776BA B9002
Nebulizers A7005 E0570, E0572, and E0585
Negative Pressure Wound Therapy A7000 E2402
TENS A4557, A4595, E0731 E0720, E0730
Walkers E0156 E0130, E0135, E0140, E0141, E0143, E0148, and E0149

Do not use the KG modifier if the accessory is billed with a different base item.

If you bill an accessory with the KG modifier without one of the base items listed above, the claim will be rejected. You can correct and resubmit any claims rejected for a missing KG modifier.

Not sure if the patient lives in a former CBA? Use the new search option #5 on the CGS Fee Schedule to determine if a patient's zip code is in a former CBA.

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