Medical Billing Forum

Coding => Coding => Topic started by: datwood on May 08, 2013, 01:48:52 PM

Title: ABN and modifier GA
Post by: datwood on May 08, 2013, 01:48:52 PM
Hello,
I was reading one of the post you have with regards to the Zostavax.  When we submit the claim to Medicare do we have to put a GA modifier to let them know that patient has signed the ABN?

Thank you,
D
Title: Re: ABN and modifier GA
Post by: RichardP on May 08, 2013, 09:18:49 PM
From here:

http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-ga.shtml

Appropriate Usage [of GA Modifier]:

 * Indicates the expected denial that an item or service is not reasonable and necessary
 * The most common example of these situations would be services adjudicated under a Local Coverage Decision (LCD).
 * The presence or absence of this modifier does not influence Medicare's determination for payment.
 * It is appropriate to report this modifier when the beneficiary refuses to sign the ABN.
 * If Medicare determines that the service is not payable, the claim denial is under a "medical necessity denial."
Title: Re: ABN and modifier GA
Post by: datwood on May 09, 2013, 03:48:08 PM
Thank you Richard!