What is a Modifier?
A coding modifier is sometimes used in medical billing, providing additional details about a procedure code, without altering its definition.
When filling out a CMS1500 form, modifiers are placed in box 24D, positioned to the right of the CPTⓇ code. The form allows for the inclusion of up to four modifiers.
GZ Modifier Definition
The GZ modifier is defined as, “item or service expected to be denied as not reasonable and necessary.”
When to Use the GZ Modifier
If a Medicare beneficiary is getting a service that is expected to be denied by Medicare, as it is considered medically unnecessary, an Advance Beneficiary Notice (ABN), must be filled out by the patient. This transfers financial responsibility to the patient.
If the ABN was not obtained, the GZ modifier should be used. In this situation, the patient cannot be held financially liable and cannot be billed.
Other ABN Claim Reporting Modifiers
- GA Modifier – “Waiver of Liability Statement Issued, as Required by Payer Policy”
- GX Modifier – “Notice of Liability Issued, Voluntary Under Payer Policy”
- GY Modifier – “Item or Service Statutorily Excluded or Does Not Meet the Definition of Any Medicare Benefit”