Suspension of Automatic Denial of Institutional Claims Reporting Modifier -GA

This article is based on Change Request (CR) 7106, which directs Medicare contractors to notify you that services submitted with the modifier ñGA on institutional claims will not be subject to automatic denial until further notice.

In October 2009, CMS issued CR 6563, entitled “Billing for Services Related to Voluntary Uses of Advance Beneficiary Notices of Noncoverage (ABNs)”, effective April 1, 2010. CR 6563 changed processing of institutional claims with the modifier ñGA and directed Medicare contractors processing institutional claims to automatically deny line items submitted with the modifier -GA. Until further notice, such denials have since been subsequently suspended at the direction of CMS.