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Pediatric Allergy Testing

Tina Posted Tue 09th of August, 2016 15:16:58 PM
Our practice is ready to start implementing allergy testing and immunotherapy. We are planning on using an ABN for services not covered by insurance companies. Is the GA modifier the appropriate modifier to use when providing allergy services? How is the modifier used when billing for the allergy testing services and immunotherapy services? Do we attach the modifier to the testing code and the immunotherapy code or other?
SuperCoder Answered Wed 10th of August, 2016 01:37:29 AM
The –GA modifier (Waiver of Liability Statement Issued as Required by Payer Policy) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions. Effective April 1, 2010, Fiscal Intermediary (FI) and Part A MAC systems will automatically deny services billed with modifier GA. An ABN Form should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. So, in your case, Yes, you can append modifier -GA on Allergy Immunotherapy CPT codes 95115-95199 accordingly.

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