An Advance Beneficiary Notice (ABN; sometimes called a patient waiver form) is used to document that the patient is aware that Medicare may not pay and has agreed to pay the provider in the event payment is denied. Each ABN must be specific to the service provided and the reason that Medicare may not pay for the service. Blanket waivers for all Medicare patients are not allowed.
The CPT code modifier, -GA (Waiver of Liability Statement on file), is used to indicate that the provider has notified the Medicare patient that the test performed may not be reimbursed by Medicare and may be billed to the patient.
An ABN (Waiver of Liability) must:
- (a) be in writing;
- (b) be obtained prior to the beneficiary receiving the service;
- (c) clearly identify the particular service;
- (d) state that the provider believes Medicare is likely to deny payment for the service;
- (e) give the reason(s) that the provider believes that Medicare is likely to deny payment for the specific service; and
- (f) include the beneficiary's signature and date.
The sample ABN shown meets the statutory requirements as outlined above.