In this article, I will explain the 4 sets of modifiers that could be applicable to the advance beneficiary notice of non-coverage (ABN) form that is used for traditional Medicare beneficiaries.
What are the advance beneficiary notice of non-coverage modifiers?
What is the description of each of the modifiers?
When would I use each of the modifiers?
Does the Centers for Medicare and Medicaid have any resources regarding the ABN?
I hope you found this article informative and that you now have a better understanding of the modifiers associated with the ABN form. In addition, be sure to read my ABN FAQs for answers to some of the more common questions I receive regarding the ABN form. Thank you for being a Gold Member!
All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
Hello! I have a question about providing outpatient telehealth PT services after the PHE is no longer extended. Because this is a never-covered service, based on what I read above we would affix the GX or GY modifier to each CPT code and submit to Medicare, get denied, and then receive cash payment up front or after the fact? We can collect before the visit, correct?
Given that we know that this is never-covered (after the PHE is over) are we required to submit this to Medicare, or could we document and bill entirely as a “self pay” service after discharging? Are we also still held accountable to progress note and POC requirements because they are a Medicare beneficiary, even though it’s a never covered service?
Please read my June 2, 2021 ABN question: Must I issue an ABN to a Medicare beneficiary for a service and/or item that is statutorily noncovered by the Medicare program?