Medicare's ABN Booklet Revised
July 29th, 2021 - Wyn Staheli, Director of Research
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):
- 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. |
- 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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