Wiki Use of ABN for Non-covered services with a CO denial

[Staceyh0620]

Hello,
With my previous employers we have always been able to hold the patient liable with a non-covered CO96 denial with a valid ABN waiver on file.
My current employer will not bill the patient unless we get a PR denial on a non-covered code with a valid ABN on file.
Does anyone have any insight? I feel we should be able to hold the patient liable if the wavier is signed ahead of service and explained to the patient regardless of the CO denial.

 

[lorettah]

Are you using the GA modifier?

 

[Staceyh0620]

@lorettah Yes we have tried GA, GY and GP. These are other modalities codes bill with the manipulation codes for chiro. Example - 98940, 98941, or 98942 billed with 97012. Some payers do put 97012 out to PR but most don't.