Medical Billing Forum

Billing => Billing => Topic started by: pvtbiller on January 03, 2013, 01:57:29 PM

Title: ABN Modifier Help Please!
Post by: pvtbiller on January 03, 2013, 01:57:29 PM
Good Afternoon Everyone,

I have a question that I am totally stumped on.  Please help!  I have a DME item that I needed to issue a voluntary ABN for.  The patient has paid up front but I am hoping to get payment from Medicare (eventually) and then refund the patient.  What modifier should I use?  GY - GX?  I don't want it to automatically deny but I think they may deny it as not medically necessary or convenience.  Thank you in advance! :)
Title: Re: ABN Modifier Help Please!
Post by: Michele on January 03, 2013, 08:16:49 PM
I got the following info from http://www.capturebilling.com/commonly-used-medicare-modifiers-ga-gx-gy-gz/

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.