Modifier GA

Definition

Waiver of liability statement issued as required by payer. The provider has provided an Advance Beneficiary Notice of Noncoverage (ABN) to the patient.

Appropriate Usage

  • 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"

Inappropriate Usage

  • 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

 

Last Updated Fri, 28 Feb 2020 13:06:13 +0000