Modifier GA can be added to a CPT code if a payer needs an ABN (Advance Beneficiary Notice) before the patient can receive a service or item that is probably not covered by Medicare.
1. What Is Modifier GA?
Modifier GA is appended to a code to indicate either an ABN (Advance Beneficiary Notice), also known as a waiver of liability, or the patient’s receipt for services or items that medicare does not cover because they consider it not necessary or reasonable.
A denial from medicare might involve services that are subjected to LCD (Local Coverage Determination). This is a denial by medicare that is based on the policies of a specific carrier or intermediary
The Advance Beneficiary Notice is used to inform patients that Medicare (probably) will not pay for the services or items and that it is the patient’s financial responsibility.
Modifier GA is officially described by the HCPCS manual as: “Waiver of liability statement issued as required by payer policy, individual case.”
3. Billing Guidelines
Modifier GA can be reported with a procedural code if the patient refuses to sign the Advance Beneficiary Notice.
It is not allowed by Medicare to use Advance Beneficiary Notice routinely. You can only use it for services that have a frequency limit on coverage.