Modifier GA

Definition

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

Correct Use

  • 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"

Incorrect Use

  • 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 Mon, 20 Aug 2018 13:45:11 +0000