JAN 20, 2023
Commercial Denial of -GA Modifier
Question: We recently billed an OCT with -GA modifier, and it was denied by Blue Care Network Advantage plans. They state the -GA modifier is not needed, and we should delete it.
Modifier -GA indicates that there is a signed advanced beneficiary notice (ABN) on file for the test/procedure. ABNs are used for Medicare Part B beneficiaries only and when the services may not be covered. It is not appropriate to use this document with any other payer, including Medicare Advantage plans. Payers may have their own waiver of liability form or require a predetermination prior to the services. Find more on how to use ABNs
on the Academy website.