Final answer:
ABN modifiers are used in Medicare billing to indicate that a patient was informed that Medicare might not cover a service and that they may be financially responsible if Medicare denies payment. Common modifiers include GA, GX, GY, and GZ, which denote specific scenarios concerning Medicare coverage determinations.
Step-by-step explanation:
ABN modifiers indicate that an Advance Beneficiary Notice of Noncoverage (ABN) was provided to a patient. The ABN is used in the context of Medicare billing to notify a patient that Medicare may not cover a particular service, procedure, or item. The ABN serves to inform the patient that they may be responsible for the payment if Medicare denies coverage. Healthcare providers use modifiers on the Medicare claim to indicate that an ABN has been issued, ensuring that the claim is processed with full knowledge that the patient understands their financial liability.
Common ABN modifiers include GA, GX, GY, and GZ. For example, the GA modifier is used when the provider has issued an ABN and believes that Medicare will deny payment for reasons not related to medical necessity, while GY and GZ are used in different scenarios regarding coverage determinations.