The GA modifier indicates a waiver of liability statement is on file. Use the GA modifier when the patient has signed an Advance Beneficiary Notice (ABN). An ABN notifies the patient that a service may not be covered by Medicare and places financial responsibility with the patient in the event of a denial. An ABN is only necessary when you think an acute condition may be misinterpreted as a chronic condition based on the documentation. Do not use an ABN unless you feel a claim may be denied for medical necessity.
We encourage practitioners to know the differences between an acute and a chronic condition and maintenance therapy, and to ensure the patient’s documentation clearly identifies an acute condition to avoid improper charges to patients.
If a claim denies where the GA modifier was used, you must appeal in writing or resubmit the claim. No phone review is available for the GA modifier. Refer to the Appeals Filing topic for more information.