Apurva Posted Wed 06th of November, 2019 08:50:27 AM
when cpt 91065 and 82542 IS BILLED AND WE HAVE AN ABN SIGNED can we bill with GX AND GY SO THAT CPT 91065 will be denied ,since 91065 is gettin payed by MCR
SuperCoder Answered Thu 07th of November, 2019 07:45:52 AM
Thank you for your question.
As per above limited information that we have an ABN signed, try to bill 91065 with modifier GA (Waiver of liability statement issued as required by payer policy, individual case). This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare. Use of this modifier ensures that upon denial, Medicare will automatically assign the beneficiary liability.
However, if your documentation indicate that a voluntary ABN was issued for services that are not covered. Then we will go for modifier GX (Notice of Liability Issued, Voluntary Under Payer Policy). Report this modifier only to indicate that a voluntary ABN was issued for services that are not covered. Medicare will automatically reject claims that have the –GX modifier applied to any covered charges.
Feel free to ask for any further question.