GX Modifier may be reported with GY Modifier and TS Modifier, but not to be reported with EY, GA, GL, GZ, KB, QL or TQ Modifiers.Īppend GY Modifier to notify Medicare that you know this CPT is statutorily excluded and will not be covered.GA Modifier and GX Modifier were formed to distinguish between mandatory and voluntary ABN’s respectively.Īppend GX Modifier to a CPT when a voluntary Advance Beneficiary Notice is issued to a beneficiary for any services not covered by Medicare. GA Modifier cannot be used with KX modifier while billing the DME claims.GA Modifier cannot be reported with liability related modifiers GZ, EY, GX, KB, QL, TX or TS.By this provider ensure upon Medicare denial, member will be liable to pay those services. GA modifier should be append to a CPT, for which the provider had a patient sign an ABN form because there is a possibility the service may be denied because the patient’s diagnosis might not medically necessary. So by this provider indicates that patient has signed ABN form by appending GA modifier to CPT and patient will be responsible for the charges billed, if those items or service not covered by Medicare. This GA modifier is to notify Medicare from provider that ABN is on file, and provider anticipates Medicare probably or certainly will not to cover those item or service. So don’t place any combination of GA, GY or GZ modifiers on the same claim line.Īppend GA modifier for the item or service when a carrier wants the physician to present an ABN. If provider appends GA, GY or GZ Modifiers on the same claim line as a combination, then it is invalid and claim will be denied.GA, GX, GY or GZ to be used only for Medicare beneficiaries and not to be used for members of Medicare advantage plans. As per CMS, dated on released that Advance Beneficiary notice modifiers i.e. ABN modifiers are prohibited for Medicare advantage enrollees. This ABN document is signed by the patient, stating that, in case of Medicare is not going to pay, or not covering the payment, the patient himself is liable for the payment. In other way we can say a notice the hospital or doctor gives the patient before the treatment, telling the patient that Medicare may not pay for some treatment or services. Let us know about the description of above ABN modifiers and instructions to use with a CPT code, but before moving to that part first let us learn the term ABN –Advance Beneficiary Notice.ĪBN is also known as Waiver of Liability, signed by Medicare patients. Modifiers GA GX GY and GZ are HCPCS Level II most commonly used Medicare Advance Beneficiary Notice – ABN modifiers.
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