Ophthalmic Coding Specialist Practice Test

Which modifier indicates that an ABN is on file for Medicare claims?

1. Modifier GA

2. Modifier GY

3. Modifier GO

4. Modifier GT

The correct answer is: Modifier GA

The correct choice indicates that an Advance Beneficiary Notice (ABN) is on file for Medicare claims. Modifier GA is used to signify that the provider has issued an ABN to the patient before providing a service that is expected not to be covered by Medicare. This modifier is crucial because it allows the patient to be informed in advance that they may be responsible for payment for the service should Medicare deny the claim due to lack of medical necessity or other coverage issues. Using modifier GA helps protect both the healthcare provider and the patient: the provider can collect payment from the patient if the claim is denied, and the patient is made aware upfront of their potential financial responsibility. Other modifiers listed, such as GY, GO, or GT serve different purposes. For example, GY indicates that a service is statutorily excluded from coverage, while GO is used for therapy services provided under Medicare. GT relates to telehealth services and does not pertain to the situation of an ABN being on file. Understanding the specific purposes of each modifier is essential for proper coding and billing practices in the healthcare field.