tci ED Coding & Reimbursement Alert - 2002 Issue 1

New Medicare HCPCS Modifiers

CMS will delete HCPCS modifier -GX (service not covered by Medicare) as of Jan. 1, 2002. This modifier has allowed physicians to bill Medicare for noncovered services in order to get a denial, after which the physician can submit the charges to a secondary payer. When the modifier was reported, Medicare understood that physicians were not trying to beat the system and obtain inappropriate reimbursement. Instead, it signaled that they knew it wasnt covered and needed an explanation of medical benefits (EOMB) to confirm the denial. Two modifiers will take the place of -GX, which was used in...

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