Quick Facts

Status

GA

Modifier GA

Waiver of Liability Statement Issued as Required by Payer Policy (Advance Beneficiary Notice on File)

Active

Global Period

Not Applicable

Modifier

GA

Applies To

Services Expected to Be Denied

Category

Use With

Medicare

CPT & HCPCS Codes

What is Modifier GA?

Modifier GA is used to indicate that an Advance Beneficiary Notice of Noncoverage (ABN) was issued to the patient because the provider expects Medicare may deny the service as not medically necessary. The signed ABN informs the patient of their potential financial responsibility before the service is provided.

When Modifier GA is reported correctly, Medicare can process the claim and, if denied, assign financial liability to the beneficiary according to Medicare policy.

When to Use

  • An ABN has been signed before the service is provided.

  • The provider expects Medicare may deny the service due to medical necessity.

  • The service is still performed after the patient acknowledges potential financial responsibility.

  • Medicare billing rules require documentation of an ABN.

Documentation Requirements

  • Signed Advance Beneficiary Notice (ABN).

  • Documentation supporting why denial is anticipated.

  • Medical necessity documentation.

  • Physician order, when applicable.

  • Complete medical record supporting the service provided.

Examples
Example 1

A physician orders a screening service that Medicare is expected to deny because it does not meet medical necessity requirements. The patient signs an ABN before receiving the service. Modifier GA is appended to the claim.

Example 2

A diagnostic imaging study is likely to be denied because Medicare's coverage criteria are not met. The provider obtains a signed ABN before performing the study and reports Modifier GA.

Billing Tips

  • Use Modifier GA only when a valid ABN is on file.

  • Obtain the ABN before providing the service.

  • Do not use Modifier GA if no ABN was signed.

  • Follow Medicare and payer-specific billing requirements.

  • Maintain the signed ABN in the patient's record.

Common Denial Reasons

  • No valid ABN on file.

  • ABN obtained after the service was performed.

  • Documentation does not support expected denial.

  • Incorrect use of Modifier GA with incompatible modifiers.

  • Incomplete medical record.

Related Modifiers
Modifier GX

Voluntary Notice of Liability Issued

Modifier GY

Statutorily Excluded Service

Modifier GZ

Expected Denial Without an ABN

Modifier 25

Significant, Separately Identifiable E/M Service

Additional Resources

Modifier GA is commonly used for Medicare claims when a provider expects a service may be denied for lack of medical necessity and has obtained a valid Advance Beneficiary Notice (ABN). Proper documentation and a signed ABN help ensure the claim is processed correctly and establish patient financial responsibility if Medicare denies coverage.