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National
Government Services, Inc.
Medicare Monthly Review Part A and B |
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A
Combined Part A and Part B Newsletter |
MMR-2007 12B, December 2007
Acupuncture Billing Clarification
Effective for claims received December 1, 2007, National Government Services, Inc. will deny acupuncture (procedure codes 97810, 97811, 97813, 97814) as not reasonable and necessary.
Previously, acupuncture was denied as a “noncovered” service. However, the correct denial for acupuncture is a medical necessity denial, and therefore, the physician must give the beneficiary an Advance Beneficiary Notice ( ABN).
- The GA modifier should be reported on the claim with the procedure code to indicate that an ABN has been signed by the beneficiary.
- The GZ modifier should be reported on the claim with the procedure code to indicate that an ABN has not been signed by the beneficiary.
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