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Effective Jan. 1, 2026, new modifiers are required to be appended to each HCPCS billed for lymphedema compression treatment items, pneumatic compression devices and related supplies, and ventilator and related supplies. Billing claims without these modifiers will result in a claim rejection for missing information. 

The SC modifier should be appended when all the statutory and reasonable and necessary requirements are met. Appending this modifier serves as an attestation by the supplier that all requirements have been met. 

If the item(s) do not meet coverage criteria, either the GA, GY, or GZ modifiers must be appended. 

• Modifier GA indicates a waiver of liability is on file since you expect the claim to be denied as not reasonable and necessary. This denial holds the beneficiary liable. 
• Modifier GY indicates the item is statutorily excluded or does not meet any Medicare benefit. This denial holds the beneficiary liable. 
• Modifier GZ indicates the claim is expected to be denied as not reasonable and necessary, however the supplier chooses to accept liability with no waiver of liability on file. This denial holds the supplier liable. 

Additional modifiers may be required, including RT, LT, or RA based on coverage requirements. We recommend reviewing the documentation to determine which modifiers are applicable.  

Correct coding and billing for each of these product categories has been published by the Joint DME MAC with links to the articles provided for both Noridian and CGS. 

• Lymphedema Compression 
  • Lymphedema Compression Treatment Items - Correct Coding and Billing - Revised - JA DME - Noridian
  • Lymphedema Compression Treatment Items – Correct Coding and Billing – Revised 
• Pneumatic Compression Devices 
  • Pneumatic Compression Devices - Correct Coding and Billing - Revised - JA DME - Noridian 
  • Pneumatic Compression Devices – Correct Coding and Billing – Revised - Revised
• Ventilators 
  • Correct Billing and Coding of Ventilators - Revised - JA DME - Noridian  
  • Correct Billing and Coding of Ventilators – Revised 

Reach out to The van Halem Group if you have any questions.