The below provides clarification on the appeal rights (by party to an appeal) for the following:
- Claim has been submitted and processed with a liability modifier(s) but appellant wishes to remove it/them
- 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. - Neither removal nor addition of GA modifier can be done through Reopening process
- Suppliers may submit a Redetermination request to remove or add GA modifier
- If adding GA modifier, suppliers must submit a valid ABN along with supporting medical documentation
|
| GX | Beneficiary: Yes.
Supplier: Yes. - Neither removal nor addition of GX modifier can be done through Reopening process
- Line-item will deny as beneficiary-liable.
- Suppliers may submit a Redetermination request to remove or add GX modifier
- If adding GX modifier, suppliers must submit a valid voluntary ABN along with supporting medical documentation
|
| GY | Beneficiary: Yes.
Supplier: Yes. - Neither removal nor addition of GY modifier can be done through Reopening process
- Suppliers may submit a Redetermination request to remove or add GY modifier
- 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. - Line-item will deny provider-liable and must be appealed. Neither removal nor addition of GZ modifier can be done through Reopening process
- Suppliers may submit a Redetermination request to remove or add GZ modifier
- If adding GZ modifier, suppliers must submit supporting medical documentation
|
