CR 6563 announces recent instructions for the use of modifiers in association with Advance Beneficiary Notices (ABN). Specifically, effective April 1, 2010, two HCPCS level 2 modifiers have been updated to distinguish between voluntary, and required, uses of liability notices. Those modifiers are:
- Modifier â€“ GA has been redefined to mean "Waiver of Liability Statement Issued as Required by Payer Policy," and should be used to report when a required ABN was issued for a service.
- A new modifier (-GX) has been created with the definition "Notice of Liability Issued, Voluntary Under Payer Policy" and is to be used to report when a voluntary ABN was issued for a service.
You should be aware of some details in the use of these modifiers.
- Medicare systems will automatically deny lines submitted with the -GA modifier and covered charges on institutional claims;
- Medicare systems will assign beneficiary liability to claims automatically denied when the â€“GA modifier is present; and
- Medicare will use claim adjustment reason code 50 (These are non-covered services because this is not deemed a â€˜medical necessityâ€™ by the payer.) when denying lines due to the presence of the â€“GA modifier.
- Medicare systems will recognize and allow the â€“GX modifier on claims, but will return your claim if the â€“GX modifier is used on any line reporting covered charges;
- Medicare systems will allow the â€“GX modifier to be reported on the same line as the following modifiers that indicate beneficiary liability: -GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit), -TS (Follow-up service);
- Medicare systems will return your claim if the â€“GX modifier is reported on the same line as any of the following liability-related modifiers: -EY (no doctor's order on file), -GA, -GL (medically unnecessary upgrade provided instead of non-upgraded item, no charge, no ABN), -GZ (item or service expected to be denied as not reasonable and necessary), -KB (Beneficiary requested upgrade for ABN, more than four modifiers identified on claim), -QL (Patient pronounced dead after ambulance is called), -TQ (basic life support transport by a volunteer ambulance provider);
- Medicare systems will automatically deny lines (using claim adjustment reason code 50) submitted with the -GX modifier and non-covered charges, and will assign beneficiary liability to claims automatically denied when the â€“GX modifier is present.