Medicare will automatically reject claims that have the –GX modifier applied to any covered charges. Modifier –GX can be combined with modifiers –GY and –TS (follow up service) but will be rejected if submitted with the following modifiers: EY, GA, GL, GZ, KB, QL, TQ.

The GZ modifier indicates that an ABN was not issued to the beneficiary and signifies that the provider expects denial due to a lack of medical necessity based on an informed knowledge of Medicare policy.

The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member. If you bill us for services using the GZ modifier, the claim will go to provider liability and you may not bill the member.

Use this modifier to report when you expect Medicare to deny payment of the item or service due to a lack of medical necessity and no ABN was issued. This modifier is an informational modifier only. Medicare will auto-deny services submitted with a GZ modifier.

Medicare requires that modifier –25 always be appended to the emergency department (ED)E/M code (99281-99285) when provided on the same date as a diagnostic medical/surgical and/or therapeutic medical/surgical procedure(s).

A modifier is a code that provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code.

The Centers of Medicare and Medicaid Services (CMS) requires that Modifier 25 should only be used on claims for E/M services, and only when these services are provided by the same physician (or same qualified nonphysician practitioner) to the same patient on the same day as another procedure or other service.

Payment modifiers include: 22, 26, 50, 51, 52, 53, 54, 55, 58, 78, 79, AA, AD, TC, QK, QW, and QY. Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) should be listed after the payment modifier.

Modifier 59 is one of the most used modifiers. You should only use modifier 59 if you do not have a more appropriate modifier to describe the relationship between two procedure codes. Modifier 59 identifies procedures/services that are not normally reported together.

There are two types of modifiers: adjectives and adverbs.

The GZ modifier must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an Advance Beneficiary Notification (ABN) signed by the beneficiary.

The GZ modifier indicates that an ABN was not issued to the beneficiary and signifies that the provider expects denial due to a lack of medical necessity based on an informed knowledge of Medicare policy.

GA Modifier: Waiver of Liability Statement Issued as Required by Payer Policy. This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare. Use of this modifier ensures that upon denial, Medicare will automatically assign the beneficiary liability. GX Modifier:

The following Medicare modifiers – GA, GX, GY, GZ. Should be used when submitting charges to indicate that an ABN (Advanced Beneficiary Notice) was issued. Commonly Used Medicare Modifiers – GA, GX, GY, GZ The following Medicare modifiers – GA, GX, GY, GZ.