Medical Billing Forum
Coding => Coding => : datwood May 08, 2013, 04:48:52 PM
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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
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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."
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Thank you Richard!