Wiki -GA Modifier

[robo50]

E & M services performed by Audiologists are non-covered services by Medicare. Because of this, we have the patient sign an ABN form and then bill the service with a -GA modifier. When the Medicare denial is received we then either bill the secondary insurance or transfer the balance to the patient. The Medicare EOB does not state that the balance is patient responsibility. Our local Medicare carrier is telling us that we are not allowed to bill the patient. I though that once you have an ABN this was perfectly acceptable. Can anyone offer an opinion on this.

 

[dclark7]

You are using the incorrect modifier. If a service is statutorily excluded and you get a (voluntary) ABN you should be using GX, not GA. GA is only used if a usually covered service MAY NOT be covered because of Medicare may not consider it medically necessary, or there are quantity limits or LCD limitations (ie specific dx codes not covered). Check the CMS website for ABN guidance.