tci General Surgery Coding Alert - 2003 Issue 9

Reader Question: Submit Modifier -GA When You Use an ABN

Question: Do we have to report modifiers -GA and -GX for all claims that we know Medicare will deny? Texas SubscriberAnswer: Even when you know that Medicare will deny a given service, you must still file a claim with the patient's carrier. Append modifier -GA (Waiver of liability statement on file) to all CPT codes covered by an advance beneficiary notice (ABN). An ABN informs Medicare beneficiaries that Medicare may not cover a particular service or procedure, and it notifies the patient of his or her responsibility to pay if Medicare does not. The ABN must clearly identify the...

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