I often receive questions when a Medicare beneficiary exceeds the therapy cap that go something like this: Currently, I have a patient that has gone over the $2010 or $3000 amount for Medicare. She has not progressed and responded to therapy interventions. She insists that her secondary will pick up the full amount if Medicare denies. I’ve used the GA modifier basically telling Medicare the therapy services are not necessary and had the patient sign an advance beneficiary notice of noncoverage (ABN) form. Will the secondary pay if the Medicare program denies? Does it matter if the secondary insurance is a supplemental insurance or a true secondary insurance?
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