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Details In The Use of These Modifiers
Modifier âGA has been redefined to mean âWaiver of Liability Statement Issued as Required by Payer Policy.â
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 âGA 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 âmedical necessityâ by the payer.") when denying lines due to the presence of the âGA modifier.
A new modifier, -GX, has been created with the definition âNotice of Liability Issued, Voluntary Under Payer Policyâ which should be used to report when a voluntary ABN was issued for a service.
Providers may use the âGX 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 âGX modifier must be submitted with non-covered charges only. FIs or A/B MACs will deny the claim as a beneficiary liability.
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