Sunday, October 2, 2016

Usage of Modifier GA , GK, GL , GY AND GZ



GA  Waiver of Liability Statement Issued, as Required by Payer Policy

ABN required; beneficiary liable
To signify a line item is linked to the mandatory use of an ABN when charges both related to and not related to an ABN must be submitted on the same claim
Line item must be submitted as covered; Medicare makes a determination for payment


GK  Reasonable and Necessary Item/Service Associated with a –GA or –GZ modifier


ABN required if –GA is used; no liability assumption since this modifier should not be used on institutional claims
Not used on institutional claims. Use –GA or –GZ modifier as appropriate instead
Institutional claims submitted using this modifier are returned to the provider



GL Medically Unnecessary Upgrade Provided instead of Non-Upgraded Item, No Charge, No ABN

Can’t be used if ABN/HHABN is required, COPs may require notice, recommend documenting records; beneficiary liable
Use only with durable medical equipment (DME) items billed on home health claims (TOBs: 32x, 33x, 34x)
Lines submitted as non-covered and will be denied
GY  Modifier -  Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit

Non-covered by Medicare Statute (ex., service not part of recognized Medicare benefit)
Optional notice only, unless required by COPs; beneficiary liable
Use on all types of line items on provider claims. May be used in association with modifier –GX.
Lines submitted as non-covered and will be denied

GZ  Item or Service Expected to Be Denied as Not Reasonable and Necessary

May be non-covered by Medicare
Cannot be used when ABN or HHABN is actually given, recommend documenting records; provider liable
Available for optional use on demand bills NOT related to an ABN by providers who want to acknowledge they didn’t provided an ABN for a specific line
Lines submitted as non-covered and will be denied

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