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GZ Modifier Chart

The GZ modifier is used when a service is expected to be denied by Medicare as not reasonable or necessary, and no advance beneficiary notice (ABN) was signed. Using the GZ modifier notifies Medicare that you expect denial but does not influence the coverage decision. If Medicare denies the claim, the beneficiary is not liable for payment. However, if Medicare pays despite the GZ modifier, it has no effect. The GZ modifier reduces risks if an ABN was not obtained when one was required.

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69 views1 page

GZ Modifier Chart

The GZ modifier is used when a service is expected to be denied by Medicare as not reasonable or necessary, and no advance beneficiary notice (ABN) was signed. Using the GZ modifier notifies Medicare that you expect denial but does not influence the coverage decision. If Medicare denies the claim, the beneficiary is not liable for payment. However, if Medicare pays despite the GZ modifier, it has no effect. The GZ modifier reduces risks if an ABN was not obtained when one was required.

Uploaded by

vidhunen
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GZ modifier

"Item or service expected to be denied as not reasonable and necessary." (No signed ABN on file.)
Description When to use the Examples of its What happens if you use the GZ What happens if you don't
GZ modifier use modifier? use the GZ modifier?
Item or service When you think a service When you would The claim will be reviewed by You never need to use the
expected to be denied will be denied because it have given an Medicare like any other claim and GZ modifier when you
as not reasonable and does not meet Medicare ABN to a patient may or may not be denied. The expect Medicare to pay.
necessary* and an program standards for but could not carrier will NOT use the presence of
advance beneficiary medically necessary care because of an the GZ modifier to influence its You are always free to elect
notice (ABN) was not and you did not obtain a emergency care determination of Medicare coverage not to use a GZ modifier.
signed by the signed ABN from the situation, e.g., in and payment of the service.
beneficiary. beneficiary. an EMTALA The claim will be reviewed
covered situation If Medicare pays the claim, the GZ by Medicare like any other
These are the When you gave an ABN in an emergency modifier is irrelevant. claim and may or may not
so-called "medical to a patient who refused room, or in an be denied.
necessity" denials. to sign the ABN and you, ambulance If the claim is denied, the beneficiary
nevertheless, did furnish transport. generally will not be liable to pay you NOTE: The GZ modifier is
* The GZ modifier also the services, use a GZ for the service. However, even provided for physicians and
may be used with modifier on unassigned When a patient though the beneficiary is found not suppliers that wish to
assigned and claims for all physicians' was not personally liable, if you are also found not liable submit a claim to Medicare,
unassigned claims for services and DMEPOS; present at your with respect to an unassigned claim, that know that an ABN
DMEPOS where one and also on assigned premises and or an assigned claim denied for one should have been signed
of the following Part B claims for which one of could not be of the DMEPOS technical denial but was not, and that do not
"technical denials" the DMEPOS technical reached to timely reasons specified, you may be want any risk of allegation
may apply: denials is expected. sign an ABN, e.g., allowed to collect from the of fraud or abuse for
• Prohibited before a specimen beneficiary. claiming services that are
telephone If you wish to indicate to is tested. not medically necessary.
solicitation, the carrier that one of the Medicare may or may not hold you By notifying Medicare, by
• no supplier above situations exists, When you realize liable depending whether you knew the GZ modifier, that you
number, in your opinion, then you too late, only after that payment would be denied when expect Medicare will not
• failure to obtain an may elect to include the furnishing a you furnished the service. In cases cover the service, you can
advance GZ modifier on your service, that you where you gave an ABN to the greatly reduce the risk of a
determination of claim. should have given patient, or attempted to, but could not mistaken allegation of fraud
coverage. the patient an obtain a beneficiary signature, most or abuse.
ABN. likely Medicare will hold you liable.

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