Medicare's ABN Booklet Revised

July 29th, 2021 - Wyn Staheli, Director of Research
Categories:   Billing   Claims   Compliance  
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A new Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) went into effect on August 31, 2020. When it was released, there were quite a few instructions that were revised. For example, they created a bullet list of types of notifiers. 

We recently received a notification that the “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated in May 2021.  There are only two changes to this booklet. They are (information in gray boxes below are quotes):

  1. Defined notifier as follows:

    “Notifiers” are entities who issue ABNs. These entities can include physicians, practitioners, providers (including laboratories), and suppliers, and utilization review committees for the care provider.
  2. Added the following modifiers and their associated information to the modifiers section:
Modifier When to Use Modifier
–GK Reasonable and Necessary Item/Service Associated with GA or GZ Modifier Report when upgrading a piece of equipment. If you have an ABN, bill with –GA. If you don’t have an ABN, bill with –GZ.
–GL Medically Unnecessary Upgrade Provided Instead of Non-Upgraded Item, No Charge, No ABN Report when you provide an upgraded item, but don’t charge Medicare or the patient for the non-upgraded item, and you didn’t issue an ABN

Neither of these are necessarily major changes, but rather clarifications to the instructions. Note that modifiers GK and GL are not recent additions to the code set — they have been around for quite awhile. These new “when to use modifier” instructions are helpful in understanding their proper usage in relation when reporting upgraded equipment/item.

Noridian has a web page specifically devoted to upgrading equipment. If this is something that your organization does, be sure to review any information or policies provided by the payer.

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