FAQ – ABN

Question – June 11, 2021

When a Medicare beneficiary reaches the targeted medical review dollar threshold of $3000 in calendar year 2021, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – June 2, 2021

Can I use the ABN form for Medicare Advantage (MA) patients to inform the patient I expect their insurance not to pay for a service or item and shift financial responsibility to the MA patient?

Answer

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Question – June 2, 2021

Must I issue an ABN to a Medicare beneficiary for a service and/or item that is statutorily noncovered by the Medicare program?

Answer

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Question – April 5, 2021

If a Medicare beneficiary has exceeded the therapy dollar threshold in 2021 and I believe further therapy is not medically necessary and the patient has signed an ABN and selected Option 1 under Section G, must I use the KX-modifier and bill the Medicare program for those services provided that are covered under the signed ABN?

Answer

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Question – April 5, 2021

When a Medicare beneficiary reaches the therapy dollar threshold of $2110 in calendar year 2021, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – April 5, 2021

If a Medicare beneficiary has exceeded the therapy dollar threshold in 2021 and I believe therapy is still medically necessary, must I use the KX-modifier and bill the Medicare program for those visits and services?

Answer

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Question – November 12, 2020

If a Medicare beneficiary has exceeded the therapy dollar threshold in 2020 and I believe further therapy is not medically necessary and the patient has signed an ABN and selected Option 1 under Section G, must I use the KX-modifier and bill the Medicare program for those services provided that are covered under the signed ABN?

Answer

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Question – November 12, 2020

If a Medicare beneficiary has exceeded the therapy dollar threshold in 2020 and I believe therapy is still medically necessary, must I use the KX-modifier and bill the Medicare program for those visits and services?

Answer

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Question – November 12, 2020

When a Medicare beneficiary reaches the therapy dollar threshold of $2080 in calendar year 2020, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – July 3, 2018

If a Medicare beneficiary has exceeded the therapy cap dollar threshold in 2018 and I believe further therapy is not medically necessary and the patient has signed an ABN and selected Option 1 under Section G, must I use the KX-modifier and bill the Medicare program for those services provided that are covered under the signed ABN?

Answer

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Question – July 3, 2018

If a Medicare beneficiary has exceeded the therapy cap dollar threshold in 2018 and I believe therapy is still medically necessary, must I use the KX-modifier and bill the Medicare program for those visits and services?

Answer

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Question – July 3, 2018

When a Medicare beneficiary reaches the therapy cap dollar threshold of $2010 in calendar year 2018, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – October 25, 2017

If a Medicare beneficiary has exceeded the therapy cap dollar threshold in 2017 and I believe further therapy is not medically necessary and the patient has signed an ABN and selected Option 1 under Section G, must I use the KX-modifier and bill the Medicare program for those services provided that are covered under the signed ABN?

Answer

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Question – August 15, 2017

If a Medicare beneficiary has exceeded the therapy cap dollar threshold in 2017 and I believe therapy is still medically necessary, must I use the KX-modifier and bill the Medicare program for those visits and services?

Answer

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Question – August 15, 2017

When a Medicare beneficiary reaches the therapy cap dollar threshold of $1980 in calendar year 2017, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – November 12, 2015

When a Medicare beneficiary reaches the therapy cap dollar threshold of $1960 in calendar year 2016, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – November 12, 2015

If a Medicare beneficiary has exceeded the therapy cap dollar threshold in 2016 and I believe therapy is still medically necessary, must I use the KX-modifier and bill the Medicare program for those visits and services?

Answer

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Question – February 21, 2015

Can we have all Medicare patient’s sign a generic advance beneficiary notice (ABN) on their first visit for outpatient therapy services to protect ourselves from possible lack of payment from the Medicare program?

Answer

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Question – February 21, 2015

When a Medicare beneficiary reaches the therapy cap dollar threshold of $1940 in calendar year 2015, is an advance beneficiary notice (ABN) required if I feel therapy is still medically necessary and requires the skills of a therapist?

Answer

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Question – March 16, 2014

If a Medicare beneficiary has exceeded the therapy cap dollar threshold and I believe therapy is still medically necessary, must I use the KX-modifier and bill the Medicare program for those visits and services?

Answer

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Question – March 16, 2014

If a Medicare beneficiary or their designated representative signs an ABN, can I collect money at the time of service for the service(s) I expect the Medicare program to deny and that I listed on the ABN form.

Answer

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Question – March 16, 2014

If the Medicare beneficiary or their designated representative selects option 1 in Section G of the ABN form, is there a modifier that I must use on the CPT codes on the claim form that I expect my Medicare contractor to deny?

Answer

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Question – March 16, 2014

If the Medicare beneficiary or their designated representative selects option 1 in Section G of the ABN form, must I still bill Medicare?

Answer

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Question – March 16, 2014

I see there are 3 options to select from on the ABN form in Section G. Who selects the option; the Medicare beneficiary or the therapist?

Answer

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Question – January 21, 2014

When a Medicare beneficiary reaches the therapy cap dollar threshold of $1920, is an advance beneficiary notice (ABN) required?

Answer

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Question – December 21, 2013

During your seminar you mentioned that the advance beneficiary notice (ABN) form is not used to notify a participant of nearing the Medicare Part B therapy cap. & Is there another form or what do you recommend?

Answer

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Question – October 28, 2013

Which modifier do I need to use when filing claims above the cap that are not medically reasonable and necessary? Do I still use the –GY modifier?

Answer

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Question – October 28, 2013

Is it permitted to use the KX and GA modifier on the same day on a Medicare beneficiary?

Answer

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Question – October 28, 2013

When are therapists not required to issue an ABN for outpatient therapy services?

Answer

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Question – October 28, 2013

When a Medicare beneficiary reaches the therapy cap dollar threshold of $1900 in 2013, is an advance beneficiary notice (ABN) required?

Answer

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