Modifier GZ

Definition

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.

Correct Use

  • Append when no ABN was provided to beneficiary and services are not medically necessary
  • Submit all charges as non-covered

Facts

  • 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

Resource

 

Last Updated Oct 31 , 2022