Awareness : OBC Tips

How to Use Modifiers to Indicate the Status of an ABN

If a provider or supplier expects that the service or item furnished to the patient may be considered unreasonable and/or medically unnecessary by Medicare, an advanced beneficiary notice (ABN) should be used to inform the patient of his or her financial liability, appeal rights, and protections under the fee-for-service (FFS) Medicare program.

Providers and suppliers should use the appropriate modifier when submitting such claims to indicate whether they have or do not have an ABN signed by the patient.

Modifier criteria:

  • Modifier GZ—must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary, and they do not have an ABN signed by the beneficiary.
  • Modifier GA—must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny a service as not reasonable and necessary, and they do have an ABN signed by the beneficiary on file.