Articles in this section

See more

Managing Modifiers

Namitha Elizabeth Smart
  • Updated
Follow

Beginning July 1, 2025, Medicare is implementing a new requirement for dental claims. Administrative modifiers like KX and GY, among others, will need to be included with procedure codes when submitting claims to Medicare.

To help you seamlessly comply with this change, CareStack is introducing enhanced functionality that allows you to add these modifiers directly from both CodeStack and the Add Treatment Slide-out. This update will ensure your dental claims meet Medicare's new specifications, helping to prevent rejections and streamline your billing process.

Note: A few screenshots have been updated to showcase enhancements from the upcoming 5.42 release, which will roll out to practices by late November.

Topics Covered

Add Modifiers Against Codes

Access Modifiers from the Add Treatment Slide-out

Watch this video for a concise summary.

  • Select the patient using the Global Search Bar.
  • Hover over Clinical > select Chart.

  • Click the + Code on the top right.

On the Add Treatment slide-out that appears, 

  • After selecting the particular code,
  • Select the Modifiers as required along with other mandatory details.

  • Click Apply.

Access Modifiers from CodeStack

  • Hover over Clinical > select Treatment Planner.

  • Click on the intended Code to open the CodeStack. 

Tip: You can also navigate to the Patient's chart or Appointment slide-out to open CodeStack.

  • In the Code Details tab, under the Clinical Details section, you will find the field assigned for Modifiers.
  • Select the required Modifier(s) from the drop-down.
  • Click Save.

Note: 

  • Users can now apply up to four modifiers per code, presented in "Code – Description format" with KX and GY always at the top for easy access.
  • KX and GY cannot be used together; if both are chosen, a warning will be shown, requiring you to remove one before applying your selections.
  • Choosing modifiers remains optional, so you can always proceed without any.

Add Modifiers Against Claims

Explore this video for an in-depth walkthrough.

  • Navigate to the System Menu > select Practice Settings > Insurance Manager > Plans.

  • For the desired Dental Insurance Plan Type, click Edit.

On the Details section, 

  • Under Claim Related Settings, select Yes for Modifiers required for claim submission.
  • Click Save.

For ADA 2024 Forms,

  • The selected modifier will appear in the claim under the Forms tab.
  • If the required modifier is not already listed, navigate to the Record of Services Provided section and select the required modifiers under the Description field.
  • Click Save to finalize.

Note:

  • If ‘Modifier required for claim submission ‘ is set as Yes, the modifier will appear as mandatory in the 2024 form.
  • Modifiers will be sent over EDI if selected against the code and will be available in medical claim forms as well.

Practices can use this simple guide to learn all about accessing and managing modifiers in CareStack.

Related articles