This document is from:
MLN Matters Article #:MM7228
Posted: February 4, 2011 Related CR#: 7228
Effective Date: July 1, 2011
Auto Denial of Claims Submitted With a GZ Modifier
The GZ modifier indicates that an Advance Beneficiary Notice (ABN) was not issued to the beneficiary and signifies that the provider expects denial due to a lack of medical necessity based on an informed knowledge of Medicare policy. Medicare Contractors will automatically deny claim line(s) items submitted with a GZ modifier, effective for dates of service on or after July 1, 2011. Further, your Medicare contractor will not perform complex medical review on any claim line item(s) submitted with the GZ modifier. In addition, line items denied due to the presence of the GZ modifier will reflect a Claim Adjustment Reason Code of 50 (These services are non-covered services because this is not deemed a “medical necessity” by the payer.) and a Group Code of CO (Contractual Obligation) to show provider/supplier liability.
Click here for the complete article