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Otolaryngology Coding Alert

Reader Question:

2 Steps to Effective -GA and ABN Use

Published on Fri Jul 02, 2004

Question: Our office is having problems with modifier -GA and Medicare when billing for hearing screenings. Any idea what could be wrong?

North Carolina Subscriber

Answer: Modifier -GA (Waiver of liability statement on file) is a Level II HCPCS code that tells the provider that the patient signed an ABN (advance beneficiary notice). The ABN informs the patient that Medicare will probably not cover the service or procedure provided by the audiologist, and the patient will be responsible for the full payment for that service or procedure. Otherwise, a Medicare patient cannot be held responsible for the charges Medicare won't cover. And that means your office will have to foot the bill. Make sure you've followed these steps when submitting a claim with modifier -GA:

Validate: For the ABN to be valid, it must have five components:

  • Specific date of service
  • Name of service (prior to beneficiary signing the waiver)
  • State provider believes Medicare won't cover the service
  • State provider's specific reason(s) for believing the claim will be denied as a procedure not reasonable or medically necessary (writing "medically unnecessary" is insufficient)
  • Patient's dated signature.

    Don't Use a Blanket ABN: You must append modifier -GA to each procedure code for each possible noncovered service, and you must have an ABN for each service. You can't submit a blanket signed ABN.

    Also, make sure your ABN and your patient's ABN are identical. If the ABN is not valid, you cannot hold a patient financially responsible for a "medical necessity" denial form from Medicare. Many carriers, such as Palmetto GBA, provide ABNs that you can personalize and use.

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