We have used modifier GA for maintenance/supportive Chiropractic Manipulation for Humana Medicare Replacement plans. Humana has denied the claim stating patient not responsible and the correct modifier was not used. Is there another modifier that should be used?
“GY- Statutorily Excluded” if you know this is not a covered benefit.
“GZ – Not reasonable and necessary”
The GA Modifier is used according to the following definition, the provider or supplier has provided an Advance Beneficiary Notice (ABN) to the patient.
I would suggest reviewing the Humana policy for Chiropractic Manipulations, there are certain criteria that may be covered, which will determine the modifier usage. It will depend on if the treatment is outside of the benefit coverage or not reasonable and necessary.
Humana – Chiropractic Care Policy Number: HCS-0384-017