Are There Modifiers to Indicate if a Provider has an ABN on File?
**Editors Note: This is the fourth in a series of articles explaining the in's-and-out's of the ABN. Please watch our Website and Listserv for future articles.
There are three modifiers a provider may need when indicating if an Advance Beneficiary Notice (ABN) is on file.
- GA indicates that the provider expects Medicare will deny the services as not reasonable and necessary and the beneficiary has signed an ABN which is on file in the medical records. GA also indicates that a beneficiary or their representative refused to sign an ABN and the proper documentation is on file in the medical records.
- GY indicates an item or service is statutorily excluded or does not meet the definition of a Medicare benefit. The modifier GY does not require an ABN.
- GZ indicates that an item or service is expected to be denied as not reasonable and necessary and there is no ABN on file. The modifier GZ does not allow the provider to bill the beneficiary.
The modifiers GY and GZ should be used with the specific, appropriate HCPCS code when one is available. In case where there is no specific procedure code to describe services, a "not otherwise classified code" (NOC) must be with either the GY or GZ modifier.
