GX - JA DME

Voluntary liability notice was issued.

The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their DMEPOS item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.

Correct Use

• The beneficiary has an order for a shower chair, which is statutorily noncovered per Medicare as it is considered a convenience item. An ABN is not required as the claim will deny by Medicare as beneficiary liable. However, if the supplier chooses to issue a voluntary ABN as a courtesy to the beneficiary, the GX modifier, along with the GY modifier would be appended to the claim upon submission to Medicare for an official denial.

Incorrect Use

• Do not append to claims when an ABN has not been issued
• Do not append to claims for items that are not considered statutorily excluded or that meet a defined benefit category

Appeal Option

• A written redetermination may be requested to append a GX modifier to a claim