Corporate Compliance

Note: CMS orders all contractors to automatically deny claim line items submitted with a -GZ modifier

Medicare Insider, February 8, 2011

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Editor’s note: Judith Kares, JD, CPC, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

In two recently issued transmittals, CMS ordered all contractors – MACs, CERTs, RACs, PSCs and ZPICs – to automatically deny all claim line items with the -GZ modifier attached.  Specifically, contractors are not to perform complex medical review on those line items that are submitted with a -GZ modifier.  Although the transmittals focused primarily on applying the new edit to the claims of physicians, other practitioners and suppliers, the -GZ modifier has been used for some time by institutional providers to identify certain types of non-covered services.  These two recent transmittals are just part of CMS’ continuing efforts to clarify the definition, use and operational impact of certain modifiers intended to identify what the provider (professional, institutional, or supplier) believes to be non-covered services.

Continue reading Judith's note on the MedicareMentor Blog.



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