GK, GL Modifiers-Upgrades
GK Reasonable and necessary item ordered when a piece of equipment has been upgraded.
When billing for upgrades, suppliers must use two lines on the same claim. Line one contains the HCPCS code for the upgraded item the supplier actually provided to the beneficiary with the dollar amount of the upgraded item. If an ABN was obtained, the GA must be billed. If an ABN was not obtained, use the GZ modifier. Line two is billed with the HCPCS code for the reasonable and necessary item with modifier GK and for the full amount of that item.
Suppliers must also list the upgrade features in Item 19 of the CMS-1500 form or the electronic equivalent.
GL Item is a medically unnecessary upgrade provided instead of a standard item at no charge to the beneficiary and an ABN does not apply.
If a supplier furnishes an upgraded DMEPOS item but charges Medicare and the beneficiary for the non-upgraded item, the supplier must bill for the non-upgraded item rather than the item the supplier actually furnished. The claim is billed with the HCPCS code for the non-upgraded item with the charge of that item and modifier GL.
Item 19 of the CMS-1500 form, or the electronic equivalent, must contain the make and model of the item actually furnished and describe why it is an upgrade.
Durable medical equipment (DME ) medical billing. How to do billing for Medicare and what equipment covered by Medicare. DME Modifiers and CPT codes.
Tuesday, January 4, 2011
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