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Advance Beneficiary Notices (ABNs)

An Advance Beneficiary Notice (ABN) is a written notice that suppliers may give to a Medicare beneficiary before providing items and/or services that Medicare otherwise might pay for, but for this particular occasion is expected to deny. The ABN allows the beneficiary to make an informed consumer decision as to whether or not to receive the items or services for which he or she may have to pay out of pocket or through other insurance. An ABN should be issued prior to dispensing an item or service expected to be disallowed for the following reasons:

The current version of the Advance Beneficiary Notice of Noncoverage (ABN) is form CMS-R-131 (Exp. 6/30/2023), which you can download on the CMS Beneficiary Notice Initiative Web pageExternal Website.

ABN Claim Reporting Modifiers

Modifier When to Use the Modifer
GA – Waiver of liability statement issued as required by payer policy Report when a mandatory ABN is issued as required and is on file. A copy of the ABN does not need to be submitted with the claim, but you must have it available on request.
GX – Notice of liability issued, voluntary under payer policy Report when a voluntary ABN is issued for a service Medicare never covers because it is statutorily excluded or is not a Medicare benefit.
GY – Notice of liability not issued, not required under payer policy Report that Medicare statutorily excludes the item or service, or the item or service does not meet the definition of any Medicare benefit.
GZ – Expect item or service denied as not reasonable and necessary Report when Medicare is expected to deny payment of the item or service because it is not medically necessary and an ABN was not issued.

CGS Resources

CMS Resources

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