Health Information Management

Healthcare News: CMS issues transmittal that provides guidance on voluntary use of ABNs

JustCoding News: Outpatient, December 16, 2009

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CMS issued Transmittal 1840 in the Medicare Claims Processing Manual on October 29 that provided guidance on the voluntary use of advanced beneficiary notices (ABN).

Generally, providers must issue ABNs to patients when they expect Medicare to deny coverage for any of the following reasons:

  • The services do not meet Medicare’s medical necessity guidelines for those services
  • The services are screening services that are being provided more frequently than Medicare provides that benefit
  • The services are custodial in nature

CMS updated the following two HCPCS Level II modifiers to distinguish between voluntary, and required, uses of liability notices:

  • Modifier -GA: Use to report when you issue a required ABN for a service
  • Modifier -GX: Use to report when you issue a voluntary ABN for a service

Make sure billing staff members aware of this change, which takes effect April 1, 2010.

To learn more, access MedLearn Matters article MM6563.



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