GA - JF Part B
Modifier GA
Definition
Waiver of liability statement issued as required by payer. An Advance Beneficiary Notice of Noncoverage (ABN) has been provided to the patient.
Correct Use
- Append when ABN provided and denial expected on an item or service as it is not reasonable and necessary
- Append when ABN provided and provider determines services will not be covered based on an active Local Coverage Determination (LCD)
- Append when ABN provided and if Medicare determines that service is not payable, claim denial is under a "medical necessity denial"
Incorrect Use
- Appending when provider has no expectation that an item or service will be denied
- Appending on a routine basis for all services performed by provider
Resource
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Process Manual, Chapter 1, Section 60.4.2
- CMS Change Request (CR) 6563
Last Updated $dateUtil.getDate( $modifieddate , "MMM dd , yyyy" , $locale , $tzone )
