Wiki Modifiers GA and GX

[dballard2004]

I have confusion on the HCPCS Level II modifiers GA and GX. Per Medicare these modifiers have been updated as follows:

Modifier GA has been redefined to mean "Waiver of Liability Statement Issued as Required by Payer Policy" and should be used to report when a required ABN was issued for a service.

Modifier GX has been created with the defintion "Notice of Liability Issued, Voluntary Under Payer Policy" and is used to report when a voluntary ABN was issued for a service.

My question is, what is the difference between a required ABN and a voluntary ABN? Can someone provide with examples of when I would use these modifiers?

Thanks.

 

[jgf-CPC]

We got this from CMS and see if it helps you.

Details In The Use of These Modifiers
GA Modifier
•
Modifier –GA has been redefined to mean “Waiver of Liability Statement Issued as Required by Payer Policy.�
•
It should only be used to report when a required ABN was issued for a service and should not be reported in association with any other liability-related modifier. It should continue to be submitted with covered charges.
•
Medicare systems will automatically deny institutional claims submitted with modifier –GA as a beneficiary liability (rather than subjecting them to possible medical review). The beneficiary will have the right to appeal this determination.
•
Medicare processing of professional claims with this modifier is not changing.
•
Medicare will use claim adjustment reason code 50 ("These are non-covered services because this is not deemed a ‘medical necessity' by the payer.") when denying lines due to the presence of the –GA modifier.
GX Modifier
•
A new modifier, -GX, has been created with the definition “Notice of Liability Issued, Voluntary Under Payer Policy� which should be used to report when a voluntary ABN was issued for a service.
•
Providers may use the –GX modifier to provide beneficiaries with voluntary notice of liability, regarding services excluded from Medicare coverage by statute. In these cases, providers may report it on the same line as certain other liability-related modifiers.
•
The –GX modifier must be submitted with non-covered charges only. FIs or A/B MACs will deny the claim as a beneficiary liability.

 

[dballard2004]

Thanks.

 

[capricew]

this is how i understood the difference....

screening colonoscopy G0105 or G0121 would be billed with a GA modifier because a screening is a covered benefit but has specific parameters that must be followed in order for Medicare to pay

ie... G0105-GA dx V16.0


GX on the other hand would be used if the doctor did an upper and lower blepharoplasty.

medicare covers the upper bleph but only if certain criteria are met, but never covers the lower bleph

ie... 15823-E1,GA
15823-59,E3,GA
15823-E2,GX
15823-E4,GX

hope this helps
Caprice, CPC

 

[livdedom]

Modifier GA

Could modifier GA be used with other insurances other than Medicare? United Healthcare had given my office manager the option of using the GA modifier when billing their claims in order to extend visits beyond the allotted time (with a signed waiver) but I thought the HCPCS G modifiers could only be used to submit to Medicare.