Posted: April 19, 2022 by Quartz Staff
Medicare Modifiers Commonly Mistaken
There are four Medicare modifiers that are commonly mistaken or used inappropriately. They have a lot in common, but misuse can cause an unnecessary denial.
Here are their official descriptions and an explanation of why the specific modifier should be used.Here are their official descriptions and an explanation of why the specific modifier should be used.
- (GA) Waiver of liability statement issued as required by payer policy, individual case: Use when a service might not be covered. The patient is notified and asked to sign an ABN. The GA modifier will indicate to the payer that the provider does have an ABN on file, if the service is not covered it will be denied as the patients’ responsibility.
- (GX) Notice of liability issued, voluntary under payer policy: When a service is never covered it is not necessary to obtain an ABN. If the GX modifier is appended, it indicates that although not required an ABN was obtained as a courtesy.
- (GY) Item or service statutorily excluded, does not meet the definition of any Medicare benefit, or, for non-Medicare insurers, is not a contract benefit. If a service is never covered and no notice of liability is required under the payers’ policy, denial automatically becomes the patients’ responsibility.
- (GZ) Item or service expected to be denied as not reasonable and necessary:Although an ABN was required at the time of service, one was not obtained. This denial would be the provider’s responsibility.
Quartz Launches Mental Well-Being Programs with AbleToRead more
Quartz Continues Partnership with Milwaukee Brewers for 2023 SeasonRead more
Welcome to better well-beingRead more
Quartz Receives Richard L. Doyle Award for Successful Prior Authorization AutomationRead more
Updates to claims edit software systemRead more
New Guidance on Proton Pump Inhibitors (PPIs)Read more
Prior Authorizations: What ‘Urgent’ SignifiesRead more
Tips to Avoid Denials of ClaimsRead more
Member ID Card UpdatesRead more