ADVANCED BENEFICIARY NOTICE (ABN)

Medicare imposes coverage limitations for certain laboratory, radiology, and cardiovascular tests. An ABN must be completed by a Medicare beneficiary before Part B services are furnished that may be denied by Medicare as not “reasonable and necessary”. If the diagnosis provided by the physician does not meet the established Medicare medical necessity criteria, the referring lab, outpatient department or physician’s office must notify the Medicare patient of non-coverage and that he/she may be personally and fully responsible for payment of denied charges.

ABN contains:
Listing of the test or Part B service that is not covered for the diagnosis,
Physician or laboratory believes Medicare is likely to deny payment for the test or Part B service, Statement that the patient will be responsible for charges if payment is denied by Medicare Area for the patient to sign indicating acknowledgment and agreement to pay if the services are not paid by Medicare.

HOSPICE MODIFIERS

GV - Attending physicannot employed or paid under agreement by patients's hospice provider.

Servive related to hospice condition

use after each procedure code billed

Patients can see their attendig physician and hospice employed physicians


GW - Service not related to hospice patient's terminal condition.

use after each procedure code billed