GZ - JE Part A
The provider expects a medical necessity denial, however, did not provide an Advance Beneficiary Notice of Noncoverage (ABN) to the patient. The line item containing the GZ modifier is denied provider-liable.
- Append when no ABN was provided to beneficiary and services are not medically necessary
- Submit all charges as non-covered
- If Medicare determines that service is not payable, denial is under a "medical necessity." Denial message will indicate that patient is not responsible for payment
- If either beneficiary or provider requests a review, modifier indicates that an ABN was not given and this could help in completing review more quickly
- CMS Internet Only Manual (IOM), Medicare Claims Process Manual, Publication 100-04, Chapter 1, Section 60.4.2