What should be appended to CPT/HCPCS codes on Medicare claims when an ABN has been signed?

When a beneficiary signs an Advance Beneficiary Notice of Noncoverage (ABN), it indicates that they have been informed about the potential denial of payment for services or items received. To communicate this information to Medicare, modifiers must be appended to the relevant CPT/HCPCS codes on claims.

Using modifiers in these instances helps to clarify the situation surrounding the service or item billed. Specifically, certain modifiers are designated to indicate that the patient was made aware of their financial responsibility and that they will be billed if Medicare does not provide coverage. This allows Medicare to process the claim with the understanding that the patient was notified and accepted the potential financial liability.

Without the appropriate modifiers to indicate the presence of an ABN, claims processing may be affected, leading to denials or delays in payment. This underscores the importance of using modifiers to accurately reflect the patient's informed consent regarding coverage decisions.