A new Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) went into effect on August 31, 2020. When it was released, there were quite a few instructions that were revised. For example, they created a bullet list of types of notifiers.
We recently received a notification that the “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated in May 2021. There are only two changes to this booklet. They are (information in gray boxes below are quotes):
- Defined notifier as follows:
“Notifiers” are entities who issue ABNs. These entities can include physicians, practitioners, providers (including laboratories), and suppliers, and utilization review committees for the care provider.
- Added the following modifiers and their associated information to the modifiers section:
|Modifier||When to Use Modifier|
|–GK Reasonable and Necessary Item/Service Associated with GA or GZ Modifier||Report when upgrading a piece of equipment. If you have an ABN, bill with –GA. If you don’t have an ABN, bill with –GZ.|
|–GL Medically Unnecessary Upgrade Provided Instead of Non-Upgraded Item, No Charge, No ABN||Report when you provide an upgraded item, but don’t charge Medicare or the patient for the non-upgraded item, and you didn’t issue an ABN|
Neither of these are necessarily major changes, but rather clarifications to the instructions. Note that modifiers GK and GL are not recent additions to the code set — they have been around for quite awhile. These new “when to use modifier” instructions are helpful in understanding their proper usage in relation when reporting upgraded equipment/item.
Noridian has a web page specifically devoted to upgrading equipment. If this is something that your organization does, be sure to review any information or policies provided by the payer.