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Modifier GZ Fact Sheet

Definition

  • The provider or supplier expects a medical necessity denial; however, did not provide an Advance Beneficiary Notice (ABN) to the patient.

Example: The medical reason for performing this test does not meet medical necessity and the provider is expecting a denial. However, the provider did not give an ABN to the patient prior to performing the service.

Modifier GZ Sample

Facts

For dates of service prior to July 1, 2011:

  • This modifier is an informational modifier only.
  • Medicare will adjudicate the service just like any other claim.
  • If Medicare determines that the service is not payable, the denial is based on lack of medical necessity. The denial message will indicate that the patient is not responsible for payment.
  • If either the beneficiary or provider requests a review, the modifier tells us that an ABN was not given and this could help in completing the review quickly.

For dates of service July 1, 2011, & after:

  • Medicare will auto-deny services submitted with a GZ modifier. The denial message will indicate that the patient is not responsible for payment.
  • If either the beneficiary or provider requests a review, the modifier tells us that an ABN was not given.

Page Last Updated: Wednesday, 26-Nov-2014 12:30:23 CST