Reader Questions:
Non Medically Necessary Procedures? Let ABN Do The Talking
Published on Wed May 18, 2011
Question: Our MAC will only let us bill cerumen removal four times per year, but a Medicare patient insists on having the removal done a fifth time. What should we do?Minnesota SubscriberAnswer: You should have the patient sign an Advance Beneficiary Notice (ABN) and explain to them that Medicare will consider the fifth cleaning "not medically necessary" and as such, Medicare will only pay for four cleanings and will not pay for the fifth cleaning.As such, they will be required to pay for this cleaning themselves. The practice should not charge for an E/M in addition to the removal of the impacted cerumen unless it has an additional complaint unrelated to the impacted cerumen.After the patients agrees, understands the ABN and signs the ABN, the claim should be submitted to Medicare with a modifier GA (Waiver of liability statement on file) indicating that an ABN is signed and on file. [...]
