Modifier GX

Definition

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 Part B procedure/service because it is statutorily noncovered or does not meet the definition of a Medicare benefit.

Correct Use

  • The beneficiary has an order for a teeth cleaning, which is statutorily noncovered per Medicare. An ABN is not required as the claim will deny by Medicare as beneficiary liable; however, if the provider 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

  • An electronic or written redetermination may be requested to append a GX modifier to a claim

Resource

 

Last Updated Wed, 10 Apr 2019 11:46:43 +0000