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Printed Date: 9/22/2015
This edit is an auto denial of claim lines with a GZ HCPCS modifier indicating that the provider expects medical necessity denial and a Advance Beneficiary Notice (ABN) was not provided to the patient.
Explanation and Suggestion:
Medicare will adjudicate the service just like any other claim. If Medicare determines the service is not payable, the denial is under a 'medical necessity.' The denial message indicates patient is not responsible for payment. If either beneficiary or provider requests a review, the modifier indicates ABN was not given, and this could assist an expedient review.
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Last Updated: 12/27/2018