The below provides clarification on the appeal rights (by party to an appeal) for the following:
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Claim has been submitted and processed with a liability modifier(s) but appellant wishes to remove it/them
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Claim has been submitted and processed without a liability modifier(s) and appellant wishes to add it/them, if applicable
Although Reopenings is not an appeal level, it does offer suppliers the option to request clerical adjustments to their claims.
|
Modifier |
Appeal Rights |
|
GA |
Beneficiary: Yes.
Supplier: Yes.
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Neither removal nor addition of GA modifier can be done through Reopening process
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Suppliers may submit a Redetermination request to remove or add GA modifier
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If adding GA modifier, suppliers must submit a valid ABN along with supporting medical documentation
|
|
GX |
Beneficiary: Yes.
Supplier: Yes.
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Neither removal nor addition of GX modifier can be done through Reopening process
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Line-item will deny as beneficiary-liable.
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Suppliers may submit a Redetermination request to remove or add GX modifier
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If adding GX modifier, suppliers must submit a valid voluntary ABN along with supporting medical documentation
|
|
GY |
Beneficiary: Yes.
Supplier: Yes.
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Neither removal nor addition of GY modifier can be done through Reopening process
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Suppliers may submit a Redetermination request to remove or add GY modifier
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If adding it, suppliers may submit a valid voluntary ABN, if applicable (not required), along with supporting medical documentation
|
|
GZ |
Beneficiary: Yes; however, this may increase the beneficiary's cost-sharing responsibility.
Supplier: Yes.
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Line-item will deny provider-liable and must be appealed. Neither removal nor addition of GZ modifier can be done through Reopening process
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Suppliers may submit a Redetermination request to remove or add GZ modifier
-
If adding GZ modifier, suppliers must submit supporting medical documentation
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