Wiki GZ Modifier

[akaunisto]

I recently received a bill from a local facility and when I looked over the bill and it had a code 87506GZ. I was unfamiliar with the GZ code so I looked it up. I found on the Medicare website that it’s a modifier because they expect denial because it is not medically necessary, and the patient is not responsible for payment.

When I questioned them about it, they sent me a new bill, with the same codes, but without the modifier.

Does anyone have any thoughts or experience with this?

 

[thomas7331]

If you are not covered by Medicare, then the modifier would not apply and was probably added to your bill in error. If you are covered under Medicare however, then you would only be responsible for whatever Medicare says is your balance on this.

As you've said, the GZ modifier is normally used by a facility or physician to indicate to that they expect a denial by Medicare because the service was not necessary. If you were not notified of this in advance and did not agree to sign a waiver that you would be responsible for the charges, then you can't be billed. However, you would receive a copy of the Medicare statement for the charge indicating whether or not it actually was denied, and if so, whether or not you owe the facility any remaining balance. Ultimately the modifier does not affect you as a patient - either way you should only owe what Medicare or your insurance says is your remaining balance.

 

[CodingKing]

It likely means they realized modifier was used in error and sent a corrected billing.

 

[mitchellde]

you should look at your EOB from your insurance if it states you woe this then you do. If the facility sent you a corrected bill then they must send a corrected claim to your carrier. your should check with your carrier if you do not get a second EO.B. Last of all were you told this test was going to be performed? were you given the opportunity to decline to have it done due to the medical necessity? and were you told the diagnosis that would be used for this test. All these things must come together. I have talked to numerous patients that were only told labwork was needed and nothing more, we need to be clear with patients as to was exactly is being done and for what reason, a patient telling their payer it was what the doctor ordered is no longer good enough. If you were appropriately symptomatic this should have been good for the medical necessity but then you have no idea as to what exactly the coder tied to the lab test as the medical necessity.