Change Request 7228-2025

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The document outlines a change request (CR 7228) from the Centers for Medicare & Medicaid Services (CMS) regarding the automatic denial of claim line items submitted with a GZ modifier, effective July 1, 2011. It mandates that all Medicare Administrative Contractors (MACs) and other related entities automatically deny such claims without complex medical review. The GZ modifier indicates that an Advance Beneficiary Notification (ABN) was not issued and that the provider expects denial due to lack of medical necessity. The document also includes instructions for contractors on processing these claims and communicating with providers.

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Click ‘Get Form’ to open Change Request 7228 in the editor.
Begin by reviewing the summary of changes. This section outlines the key updates regarding the automatic denial of claim line items submitted with a GZ modifier.
Fill in any required fields, ensuring you accurately indicate the claim line items affected by the GZ modifier as specified in the document.
Refer to the business requirements table and mark your responsibilities accordingly. Use checkboxes to indicate which contractors are applicable for each requirement.
Review the provider education table for additional guidance and ensure that all necessary information is included before finalizing your submission.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is the gy modifier only for Medicare?

The basic rule is to use GY modifier only with the appropriate CPT or HCPCS codes for services or items that Medicare never covers. These may include: Personal care items. Services or items provided outside the U.S.

What is the gy modifier used for?

GA - Waiver of Liability: This modifier is used when an item or service is expected to be denied as not medically necessary, and an ABN has been properly executed according to payer policy or individual case requirements.

When to use gz modifier?

Medicare will auto-deny services submitted with a GZ modifier. The denial message indicates that the patient is not responsible for payment; deny provider liable. Use this modifier to report when you expect that Medicare will deny payment of the item or service due to a lack of medical necessity and no ABN was issued.

When should a GZ modifier be used?

GY modifier is added to claims in which the item or service is statutorily excluded, does not meet the definition of any Medicare benefit.

What is the GZ modifier for DME?

In plain terms, GZ means Medicare will deny this as not medically necessary, and we didnt get the patient to sign the usual notice. Medicare automatically denies any claim line billed with GZ. Crucially, because the patient never signed an ABN, Medicare rules say the patient is not responsible for payment.

Is gx modifier patient responsibility?

Informed Patients: The GX modifier signals that patients know they may face financial responsibility if Medicare denies coverage.

Change Request 7228-2025

Here's how it works

How to use or fill out Change Request 7228 with our platform

Complete this form in 5 minutes or less

Got questions?

Is the gy modifier only for Medicare?

What is the gy modifier used for?

When to use gz modifier?

When should a GZ modifier be used?

What is the GZ modifier for DME?

People also ask

Is gx modifier patient responsibility?

Related links

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Change Request 7228-2025

Here's how it works

How to use or fill out Change Request 7228 with our platform

Complete this form in 5 minutes or less

Got questions?

Is the gy modifier only for Medicare?

What is the gy modifier used for?

When to use gz modifier?

When should a GZ modifier be used?

What is the GZ modifier for DME?

Related Searches

People also ask

Is gx modifier patient responsibility?

Related links

Try more PDF tools