GA Modifier (2023) | Definition, Billing Guidelines, Reimbursement & Examples

The GA Modifier is applied for service when a waiver of liability statement is issued as required by payer policy, individual case. We will explain what modifier GA is and how you can use it.

Summary & Description

The official description of modifier GA is: “Waiver of liability statement issued as required by payer policy, individual case.”

GA Modifier usually appends with a CPT code when:

• It is not medically necessary and reasonable;
• the patient is responsible for the payment and has no other insurance.

ABN does issue at the time of service. If the patient has secondary insurance, it will automatically deny by Medicare and bill secondary insurance.

Evaluation and management (E/M) codes accept GA Modifier and are medically appropriate.

Be aware that only one E/M service can perform on the same date for one reason.

Another physician can report the other service if the patient encounters the same reason on the same day with modifier GA when ABN is not issued.

Medical documentation must support the medical necessity of the repeated service. It may deny by the insurance or third party. Check the appropriate guidelines for repeated services.  

Modifier GA is applied for service when a waiver of liability statement is issued as required by payer policy, individual case.

Reimbursement 

Modifier GA indicates service was not medically necessary and appropriate.

It may deny by the insurance and liability assigned to the beneficiary when a person has secondary insurance and will reimburse the service if covered. GA Modifier must use with non-covered charges.

Billing Guidelines

You may report modifier GA when the documentation does not support the medical necessity of service or is medically inappropriate.

• The patient’s condition reflects the significance of the service.  
• Service does not meet the criteria for medical appropriateness of service.
• It must indicate Modifier GA and bills on a separate line. For example, if any service requires a specific diagnosis for reimbursement.
• The service lists it as a non-covered diagnosis.
• ABN does sign by the patient. In this case, liability assigns to the patient instead of the provider.
• Radiology services require a specific diagnosis code for the services.
• Modifier can not be billed with modifier GX, modifier GY, and modifier GZ on the same line.
• GA Modifier applies to surgical and laboratory procedures as well.  
• Claim reports with the separate line when modifier GA is attached.

When To Use GA Modifier

You may use modifier GA when:

• If the physician is confident that service may deny by Medicare.
• The physician issues advance beneficiary notice before services render to the patient.
• The service seems unnecessary to the physician. Modifier 77 attaches to unbundle the service, and modifier GA indicates that Medicare denies paying for this service.

Billing Example

58 y/o male with a PMH of HTN, HLD, and hypothyroidism presents to the hospital outpatient setting because of a headache and high blood pressure before arrival.

The patient lays in bed at 10 pm and begins having a gradual onset pulsating frontal and occipital headache.

He reports that the pain was very severe. His headaches are usually associated with HTN.

The blood pressure shows a value of 210/100 and denies associated dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, abdominal pain, nausea/vomiting.

The physician ordered a series of CT, MRI, and EKG diagnostic tests. EKG was independently interpreted and reviewed by the doctor.

EKG exceeds the limits of unit performance in one day. ABN issued by the patient.

The radiologist bills the extra unit with modifier GA, and the patient is responsible for the service payment.