GA, GZ, GY Modifiers-ABN/Not Reasonable and Necessary/Statutorily Excluded
The GA modifier is submitted on claims when the supplier has an Advance Beneficiary Notice on file.
An ABN is a written notice a supplier gives to a Medicare beneficiary before items or services are furnished when the supplier believes that Medicare will not pay because there is a lack of medical necessity.
Keep in mind that not all items submitted with the GA modifier are denied as patient responsibility. Items must be denied based on medical necessity in order to receive a patient responsibility denial.
The GZ modifier is used to indicate suppliers expect Medicare will deny an item or service as not reasonable and necessary and they do not have an ABN on file.
The GY modifier is submitted when suppliers indicate an item or service is statutorily non-covered or is not a Medicare benefit.
Examples of items to use the GY modifier with are infusion drugs that are not administered through a durable infusion pump, personal comfort items and enteral nutrients administered orally. Also, many of the LCDs provide instructions on when to use the GY modifier.
Durable medical equipment (DME ) medical billing. How to do billing for Medicare and what equipment covered by Medicare. DME Modifiers and CPT codes.
Monday, January 3, 2011
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