Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2021 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Auto denial of claim line(s) submitted with a “GZ” modifier effective with July 1, 2011, dates of service for TOBs 12x, 13x, 14x, 22x, 23x, 32x, 33x, 34x, 71x, 72x, 73x, 74x, 75x, 76x, 77x, 81x, 82x, 83x and 85x.
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. 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.
CMS Internet Only Manual (IOM), Publication 100-4, chapter 30 (PDF, 1.9 MB).
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 12/16/2019