HCPCS Modifier Spotlight – ABN Modifiers

An Advanced Beneficiary Notice (ABN) is a standardized form used by healthcare providers to notify Medicare beneficiaries that a service or item may not be covered by Medicare before they receive the service/item.? The ABN form notifies patients of their financial responsibility should Medicare deny the claim. ?By signing the ABN, beneficiaries acknowledge their understanding of the potential cost.? The ABN modifiers play a crucial role in ensuring proper reimbursement and compliance with Medicare regulations and other payer requirements. ?The ABN modifiers help Medicare (and other payers) determine coverage, payment, and medical necessity for a claim.?

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The ABN Modifiers are listed below:

GA - Waiver of Liability Statement Issued as Required by Payer Policy. ?It is used to report a required?ABN?was issued for a service and is on file. ?A copy of?ABN?does not have to be submitted but must be made available upon request.

GX - Notice of Liability Issued, Voluntary Under Payer Policy. It is used to report a voluntary?ABN?was issued for a service.

GY- Notice of Liability Not Issued, Not Required Under Payer Policy. It is used to report that an?ABN?was not issued because item or service is statutorily excluded or does not meet definition of any Medicare benefit.

GZ - Item or Service Expected to Be Denied as Not Reasonable and Necessary. ?It is used to report an?ABN?was not issued for a service.

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The ABN modifiers play an important role in accurate medical billing and reimbursement. By understanding and applying the ABN modifiers correctly, healthcare providers can reduce claim denials, maintain compliance, and improve revenue cycle management.? Incorrect application of the ABN modifiers can lead to unnecessary claim denials, reduced payments, and even overpayments!