Reason Code Narrative

Auto denial of claim line(s) submitted with a "GZ" modifier effective with July 1, 2011, dates of service for TOBs 12x, 13x, 14x, 22x, 23x, 32x, 33x, 34x, 71x, 72x, 73x, 74x, 75x, 76x, 77x, 81x, 82x, 83x and 85x.

Common Reason Code Errors

• Provider submitted an outpatient claim with HCPCS modifier GZ. The GZ modifier is used to report an Advanced Beneficiary Notice of Noncoverage (ABN), was not issued for a service, an ABN may be required but was not obtained, or an ABN was obtained but is invalid.

Common Reason Code Corrections

• The item or service is expected to be denied as not reasonable or necessary.
• No provider corrections necessary. This is a valid processing reason code, which does not reflect incorrect billing.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 30