On April 5, 2010, CMS revised the Advance Beneficiary Notice of Noncoverage (ABN) modifiers. The purpose of the new modifiers is to differentiate between voluntary and mandatory use of the liability notice.

The new modifiers are:

-GA –Waiver of Liability Statement Issued as Required by Payer Policy

-GX – Notice of Liability Issued, Voluntary under Payer Policy

The Centers for Medicare and Medicaid (CMS) require a provider to notify Medicare beneficiaries when a service may not be covered under the Medicare program. The new Advance Beneficiary Notice of Non-coverage (ABN), which became effective March 1, 2009, must be completed by the provider, or his/her representative, and signed by the patient, before a service is rendered.

The retirement of a LCD is considered by many to be a blessing rather than a problem because while a LCD is active, claims denials are automatic if the requirements of the LCD are not met. This forces the provider to obtain an advance beneficiary notice (ABN). Further, laboratories must maintain a database of LCD edits and update them when LCDs change or new ones are issued. Many think this all goes away when a LCD is retired. Think again!