Q&A Where you would use a GA or GX modifier on a claim for PT?

[justine]

I am trying to figure out these new GA and GX modifiers and where and when to use them with physical therapy in a office setting. Does anyone know more about this? Some secondary insurances will still pay for PT after the Medicare benefit runs out so which one do you use and when?

 

[Ruth Sheets]

This was covered in the August 2013 Q&A Webinar. Join the Replay club to get the recorded videos from our webinars, plus the transcripts, answer sheets, and an opportunity to take a quiz that will earn you an AAPC CEU when you pass it.

Here are some highlights from the webinar for this question:
GA is "Waiver of liability statement issued as required by payer policy, individual case." This means that an ABN is on file and allows the provider to bill the patient if the service is not covered by Medicare.
GX is "Notice of liability issued, voluntary under payer policy" This means that an ABN is on file, the provider knows Medicare does not pay for the service, but is looking for a denial from Medicare so that they can bill the secondary insurance.

 

[Ruth Sheets]

What is an ABN was discussed by Alicia Scott during the July 2014 Q&A Webinar. Join the CCO Club to get the transcript, answer sheets, and view the recording of this topic (and more). When you join the CCO Club you get access to all the available monthly Q&A webinar resources.