Health Information Management

Q/A: Modifier -GA and automatic denials

APCs Insider, October 22, 2010

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Q: Is CMS still denying all line items with modifier -GA?
 

A: CMS has reversed the processing of line items with modifier –GA and will no longer automatically deny the line item according to Transmittal 770 issued September 17. Appending modifier -GA indicates the provider issued an advanced beneficiary notice (ABN) to the patient for the item.

In Transmittal 1840 issued October 29, 2009, CMS stated that, the institutional claims systems would automatically deny lines with modifier –GA, effective April 1, 2010. However, the automatic denial process did not allow Medicare contractors to review the line item to determine if the billed diagnosis supported the test

CMS’ suspension of the automatic denials is retroactive to April 1, according to Transmittal 770. However, the implementation date of the transmittal is October 17, which means that the edit was not corrected in the system until this date; therefore, contractors would have denied a line item with modifier GA up until that date.



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