Open Dental offers features that can be used for Medicare.

To see these features in Open Dental, enable Public Health and Medical Insurance in Show Features.

Modifier Codes

The claim modifers, KX and GY are used only for Medicare Part B for dental services linked to covered medical services.

• KX: Indicates requirements specified in the medical policy have been met. Claim administrators should being processing the qualifying dental claim.
• GY: Indicates item or service statutorily excluded, does not meet the definition of any Medicare benefit. Claim administrators should deny the claim to allow for subsequent coordination of benefits.

Adding Modifiers to Claims

In Procedure - Medical Tab, is the Mods area. Claim modifiers can be entered here.

Modifiers are included when sending an electronic claim and can be added to printed claim forms.

To add prepending KX# and GY# modifiers for Medicare Part B to Box 30 when printing claims:

1. In the Insurance Plan, Other Ins Info Tab, set the Filing Code to MedicarePartB.
2. Add KX or GY to the Mods fields in the Procedure - Medical Tab.

Sending Claim Modifiers

When printing the claim, KX# or GY# is prepended to the procedure description in box 30 of the ADA Claim Form.

Claim modifers are included when using the 5010 format to send electronic claims.