Description
Notice of liability issued, voluntary under payer policy.

Guidelines and Instructions

• This modifier is effective for services provided on or after January 1, 2011
• Submit this modifier if you have voluntarily obtained a valid Advance Beneficiary Notice of Noncoverage (ABN). This includes ABNs obtained for services that are statutorily denied, such as physical therapy services provided by chiropractors. You may, but are not required to, ask patients to sign ABNs for services that are statutorily denied.
  • Part B services will not automatically be denied when submitted with HCPCS modifier GX
  • Part A services will automatically be denied when submitted with HCPCS modifier GX
• You may report this modifier in addition to HCPCS modifiers GY and TS
• You may not report this modifier in addition to the following HCPCS modifiers: EY, GA, GL, GZ, KB, QL and TQ. Palmetto GBA will return as unprocessable any claims submitted with HCPCS modifier GX plus one of these modifiers with remark code MA130.