Last Modified: 3/10/2010
Location: FL, PR, USVI
Business: Part A
Effective Date: April 1, 2010
Implementation Date: April 5, 2010
Change request 6563, from which this article is taken, announces that two HCPCS level II modifiers have been updated to allow the voluntary uses of liability notices to be distinguished from the required uses. Specifically, modifier GA has been redefined to mean “Waiver of liability statement issued as required by payer policy.”
Modifier GA must only be used to report when a required advance beneficiary notice (ABN) was issued for a service. Modifier GA is not to be reported in association with any other liability-related modifier and must continue to be submitted with covered charges. Please note that the Medicare systems will now deny institutional claims submitted with modifier GA as a beneficiary liability (rather than subjecting them to possible medical review), and the beneficiary will have the right to appeal this determination. Medicare processing of professional claims with this modifier is not changing.
In addition, new modifier GX, has been created with the definition: “Notice of liability issued, voluntary under payer policy.”
Modifier GX should be used to report when a voluntary ABN was issued for a service. Providers may use modifier GX to provide beneficiaries with voluntary notice of liability regarding services excluded from Medicare coverage by statute, and in these cases, providers may report it on the same line as certain other liability-related modifiers. Please note that modifier GX must be submitted with noncovered charges only, and the FI or A/B MAC will deny the claim as a beneficiary liability.
Here is the link to the
MLN Matters article MM6563 
.
Source: MM6563
