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).

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