Eli's Rehab Report

Published on Thu Feb 28, 2008 PDF

If you offer acupuncture services in your clinic and treat Medicare patients, take note. Empire Medicare Services recently directed providers in Indiana and Kentucky to start issuing Advance Beneficiary Notices (ABNs) when performing acupuncture procedures described by 97810-97814.

Reasoning: In its Medicare Monthly Review, Empire stated, "Previously, acupuncture was denied as a 'noncovered' service. However, the correct denial for acupuncture is a medical necessity denial, and therefore, the physician must give the beneficiary an Advance Beneficiary Notice ... The GA modifier should be reported on the claim with the procedure code to indicate that an ABN has been signed by the beneficiary." If the patient has not signed an ABN, append modifier GZ (Item or service expected to be denied as not reasonable and necessary) to the procedure code, Empire said.