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Hi ,

Basically, the ABN is required for covered services that you have every reason to expect Noridian deny (typically as "medically unnecessary"), eg. maintenance care manipulation. The ABN is not required for non-covered services such as exams, x-rays, physiotherapy, etc. I have not yet had a patient refuse to sign the ABN once it was explained to them the purpose. Technically, without the signed ABN the patient is not responsible to pay. Use of the -GA modifier notifies the carrier you have a signed ABN on file for that particular service and the patient is then instructed they are responsible for payment. Also, if the secondary pays for services deemed medically unnecessary by Medicare (fat chance, I know), the ABN and -GA modifier notifies them they are then responsible.

Holzapfel DC

Albany

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