Change Request 7228-2025

Show details

4.6 out of 5

35 votes

The document outlines a change in Medicare claims processing, specifically 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 deny these claims without complex medical review and ensures consistent communication in educational materials. The GZ modifier indicates that an Advance Beneficiary Notification (ABN) was not issued, and the provider expects denial due to lack of medical necessity.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to edit Change Request 7228 in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on documents with our feature-rich and intuitive PDF editor is simple. Make the steps below to fill out Change Request 7228 online easily and quickly:

Sign in to your account. Log in with your email and password or register a free account to try the product before upgrading the subscription.
Upload a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Change Request 7228. Quickly add and underline text, insert pictures, checkmarks, and signs, drop new fillable areas, and rearrange or remove pages from your document.
Get the Change Request 7228 accomplished. Download your modified document, export it to the cloud, print it from the editor, or share it with others through a Shareable link or as an email attachment.

Make the most of DocHub, the most straightforward editor to quickly handle your documentation online!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

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

What is the GZ modifier used for?

The -GX modifier indicates you provided the notice to the beneficiary that the service was voluntary and likely not a covered service. -GY Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, and is not a contract benefit.

When should a gy modifier be used?

If you havent provided the beneficiary with a notice of the services being excluded from coverage, you should append the -GY modifier to the line item. Its use indicates that no notice of liability.

What is the use of gy?

The gray (symbol: Gy) is the unit of ionizing radiation dose in the International System of Units (SI), defined as the absorption of one joule of radiation energy per kilogram of matter.

Will Medicare pay with a GA modifier?

If Medicare pays the claim, the GA modifier is irrelevant. If the claim is denied, the beneficiary will be fully and personally liable to pay you for the service, personally or through other insurance.

When to use gy modifier for Medicare?

GY Modifier: This modifier is used to obtain a denial on a non-covered service. Use this modifier to notify Medicare that you know this service is excluded.

Does Medicare accept resubmission code 7?

The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member. If you bill us for services using the GZ modifier, the claim will go to provider liability and you may not bill the member.

What modifier to use for Medicare telehealth?

The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.

Change Request 7228-2025

Here's how it works