HCPCS Modifier GA

Description
Effective with dates of service on or after January 1, 2011, the description of this modifier has been changed to: "waiver of liability statement issues as required by payer policy, individual case."

Guidelines and Instructions

• Submit HCPCS modifier GA when there is a valid Advance Beneficiary Notice (ABN) on file for the service
• HCPCS modifier GA may not be submitted with services that are statutorily excluded. Refer to HCPCS modifier GY for these services.
• HCPCS modifier GA may not be submitted, on the same detail line, with Chiropractic modifier AT
  • Effective for dates of service on and after November 1, 2015, services submitted with both modifiers, on the same detail line, will be rejected. Rejected claims must be resubmitted as new claims.
• HCPCS modifier GA does not apply to most ambulance services. For more information regarding ABNs and ambulance services, refer to the CMS website.

ABN Background

• Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-For-Service (FFS) Medicare and Medicare Advantage (MA) Plans. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers.
• The Advance Beneficiary Notice shall be used by providers, physicians, practitioners and suppliers for all situations where Medicare payment is expected to be denied, including laboratory tests. This revised ABN must be used for services provided on or after March 1, 2009. Previous versions of this form are no longer valid as of this date. The revised ABN replaces the previous ABN-G, ABN-L and NEMB.
• All providers are required to use the CMS ABN form, available on the CMS website
• The ABN form must be presented to the patient before the service or procedure is initiated. Maintain a copy of the form in the patient's medical record.

ABN Requirements

• All providers are required to use the CMS ABN form, available on the CMS website
• It is not appropriate to ask patients to sign ABNs for every service
• The ABN form must be:
  • Reproduced as a single page (you may customize some fields of the ABN)
  • Presented to the patient before the service or procedure is initiated
  • Verbally reviewed with the beneficiary or his/her representative and any questions raised during that review must be answered before it is signed
  • Delivered far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice
• Maintain a signed copy of the form in the patient's medical record

References

• CMS ABN (Form CMS-R-131) and instructions for completion