Wiki Non covered services

[veeramani14]

Hi all,

Can anyone clarify me which modifier used to indicate when the service is not covered by medicare.

Veera.

 

[Pam Warren]

Did you get an ABN signed? That will determine which modifier to use:

GA: Waiver of liability statement isssued as required by payer policy, individual case. This means you believe it's not covered in this instance and the patient signed an ABN to verify that they're aware of their liability.

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. This means the service is never covered, and you're expecting the denial.

GX: Notice of liability issued, voluntary under payer policy. You got an ABN signed voluntarily, because you expect a denial.

GZ: Item or service expected to be denied as not reasonable and necessary. You use this one if there was no ABN signed.