Mar 17

Auto Denial of Claim Line(s) Items Submitted With a GZ Modifier

In case you haven’t heard, CMS is establishing an automated edit to deny Part A and B claim line(s) items that contain a GZ modifier. The GZ modifier indicates that the provider does not have an ABN on file and believes the services will not be covered because they were not reasonable and necessary. In addition, the transmittals instruct contractors not to conduct complex medical review on lines with the modifier.

Pub. 100-04, Trans. 2148; Pub. 100-08, Trans. 366: CR 7228 (Feb. 4; eff. July 1/impl. July 5, 2011).

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →