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Commonly Used Medicare Modifiers – GA, GX, GY, GZ

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Medicare ABN Specific Modifiers – GA, GX, GY, GZ

Medicare-ABN-GA-GX-GZ-GY-ModifiersWe get a lot of questions at our medical billing company about what modifiers to use when submitting charges to Medicare to indicate that an ABN (Advanced Beneficiary Notice) was given or not given to the patient.  These are the top 4 Medicare modifiers we use.

GA Modifier:

Waiver of Liability Statement Issued as Required by Payer Policy.

  • This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare.
  • Use of this modifier ensures that upon denial, Medicare will automatically assign the beneficiary liability.

GX Modifier:

Notice of Liability Issued, Voluntary Under Payer Policy.

  • Report this modifier only to indicate that a voluntary ABN was issued for services that are not covered.
  • Medicare will automatically reject claims that have the –GX modifier applied to any covered charges.
  • Modifier –GX can be combined with modifiers –GY and –TS (follow up service) but will be rejected if submitted with the following modifiers: EY, GA, GL, GZ, KB, QL, TQ
  • Additional information on the –GX modifier can be found at:  http://www.cms.gov/mlnmattersarticles/downloads/MM6563.pdf

GY Modifier:

Notice of Liability Not Issued, Not Required Under Payer Policy.  This modifier is used to obtain a denial on a non covered service.  Use this modifier to notify Medicare that you know this service is excluded.

GZ Modifier:

Item or Service Expected to Be Denied as Not Reasonable and Necessary.  When an ABN may be required but was not obtained this modifier should be applied.

Additional information can be found at: http://www.cms.gov/manuals/downloads/clm104c12.pdf


Medicare Modifiers - Medical Billing Services

11 Responses to “Commonly Used Medicare Modifiers – GA, GX, GY, GZ”

  1. KIM says:

    We are not participating in the Medicare program, do to the fact that the equipment we provide is not in Medicare’s fee schedule. But we need the correct denial stating not covered service. Some articles say we must use GZ and some say GA and others GX, or GY. So confused at this point just need the correct denial for Medicaid to cover any idea’s. We need the process to go smoothly and we are small enough that we will be billing on paper which will make the time span seem like forever. Please Advise!!! Thank

  2. Julie T says:

    What does exj mean at the end of a prescription?

  3. Mary Lutes says:

    This information may be confusing for inexperienced billers. Only the designated “attending physician” is eligible to use the GV modifier. All other claims related to the hospice care must go to the hospice provider. The GW modifier can be selected when it can be shown by documentation that the services are not related to the hospice care.

    Modifiers should never be changed or added to claims unless the documentation has been reviewed and the use of the modifier is appropriate based on the documentation.

    Mary Lutes, CPC

  4. Doug Harder says:

    We are an ambulance company. We are getting Medicare denials transporting patients to therapeutic/diagnostic centers (D Modifier)i.e RD is residence to diagnostic center & DR is the return modifier. The facilities are NOT physicians (P Modifier) & not hospital (H modifier). Why are we getting denials for bona fide procedures/ICD9 codes in these facilities?
    Help. Thanks

  5. Debbie Farrell says:

    Being denied consults when billing Medicare because not using proper modifier (was using AH), but can find no human being to talk to at Medicare and havce been looking on-line and can’t find. Any Help? This is for a psychological practice. It is my understanding the new consult code is 90791 (90792 for our psychiatrists).

    Thanks, Debbie

  6. […] The analysis of any medical billing or coding question is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.Source: capturebilling.com […]

  7. […] We do medical billing for physician offices that do Care Plan Oversight (CPO) for Hospice Patients.  When billing for those services, G0182, we use the following Medicare modifiers: […]

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.

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