Author Topic: ABN and modifier GA  (Read 1284 times)

datwood

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ABN and modifier GA
« 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

RichardP

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Re: ABN and modifier GA
« Reply #1 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."

datwood

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Re: ABN and modifier GA
« Reply #2 on: May 09, 2013, 03:48:08 PM »
Thank you Richard!