No Physician or Other Licensed Health Care Provider Order for this Item or Service
None, cannot be used when HHABN or ABN is required, recommend documenting records; liability is provider unless other modifiers are used (-GL, -GY, or –TS)
To signify a line-item should not receive payment when Medicare requires orders to support delivery of a item or service (i.e., TOBs 21x, 22x, 32x, 33x, 34x, 74x, 75x, 76x, 81x, 82x, 85x)
When orders required, line item is submitted as non-covered and services
Modifier GA
Waiver of Liability Statement Issued, as Required by Payer Policy
ABN required; beneficiary liable
To signify a line item is linked to the mandatory use of an ABN when charges both related to and not related to an ABN must be submitted on the same claim
Line item must be submitted as covered; Medicare makes a determination for payment
Modifier GK
Reasonable and Necessary Item/Service Associated with a –GA or –GZ modifier
ABN required if –GA is used; no liability assumption since this modifier should not be used on institutional claims
Not used on institutional claims. Use –GA or –GZ modifier as appropriate instead
Institutional claims submitted using this modifier are returned to the provider