Health Information Management

Q/A: Appending modifier -GZ

APCs Insider, May 14, 2010

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Q: Is reporting modifier –GZ (item or service expected to be denied as not reasonable and necessary) still appropriate if we did not issue an ABN with failed medical necessity?

A: Yes. Modifier –GZ is appropriate when no medical necessity was documented and no ABN was issued. Reporting this modifier indicates a provider knows that the service was provided without documentation to support medical necessity and that it will be liable for the cost of the service. Beneficiaries bear no responsibility for these services because they didn’t receive written notification beforehand. Submit charges in the non-covered column on claims.

Consult the CMS Claims Processing Manual (Pub 100-04) Chapter 1 sections 60.1.3.1 and 60.4.2. for information about this modifier and others.



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