Modifier GJ

"Opt out" physician or practitioner emergency or urgent services

Instructions

In an emergency or urgent care situation, a physician/practitioner who opts out may treat a Medicare beneficiary with whom he/she does not have a private contract and bill for such treatment. In such a situation, the provider may not charge the beneficiary more than what a nonparticipating physician/practitioner would be permitted to charge and must submit a claim to Medicare on the beneficiary's behalf.

Correct Use

  • Example - Physician was called in to see a patient in the emergency room whom he has not seen before and no contract was signed

Claim Coding Example

CPT Code Modifier
99282 GJ

 

Incorrect Use

  • Opt out physician to append for non-emergent services that have a private contract with patients.

Resource

 

Last Updated Mon, 31 Oct 2022 18:57:29 +0000