FREQUENTLY ASKED QUESTIONS 1st Quarter FY 2005 Q. What is the proper use of modifier GZ, GY and GA?
A. Modifier GA is used when an item or service is expected to be denied as not reasonable and necessary and an advanced beneficiary notice (ABN) was given to the beneficiary. You are required to use an occurrence code 32 along with your modifier GA. The services should be billed as covered. If you do not use modifier GA and occurrence code 32 on the claim, it will be reviewed as any other claim and may or may not be denied. If the claim is denied, the provider will be liable. Modifier GZ is used when an item or service is expected to be denied as not reasonable and necessary and an ABN was not signed by the beneficiary and you furnish the services anyway. Medicare will review the claim like any other claim without regard to the GZ modifier. If Medicare pays the claim, the GZ modifier is irrelevant. However, if Medicare denies the claim, the provider will be liable. This modifier does not need to be used when payment is expected by Medicare. The provider has the option to choose to use
Related Questions
- FREQUENTLY ASKED QUESTIONS FOR FY 2004, 4TH QUARTER Q. What should the provider place in the blank space on the Advance Beneficiary Notice (ABN) for a possible denial by Medicare?
- FREQUENTLY ASKED QUESTIONS 1st Quarter FY 2005 Q. What is the proper use of modifier GZ, GY and GA?
- Why are lines that are billed with the GA modifier automatically rejecting beneficiary liable?
