Modifier code
Modifier GZ: Item or service expected to be denied as not reasonable and necessary, no ABN
Provider expects Medicare denial but no ABN obtained — patient cannot be billed.
Code
GZ
When to use
Service expected to be Medicare-denied but no ABN was obtained — provider acknowledges they bear the cost.
Common issues
- Patient should not be billed if GZ-marked
Frequently asked questions
What is modifier GZ?
Item or service expected to be denied as not reasonable and necessary, no ABN
When should it be used?
Service expected to be Medicare-denied but no ABN was obtained — provider acknowledges they bear the cost.
Common issues when modifier is missing or wrong?
Patient should not be billed if GZ-marked.
Other modifiers
- 25 — Significant, separately identifiable E&M service on same day as procedureWhen E&M visit + procedure happen same day and the E&M was separately documented
- 26 — Professional componentSplits a procedure into its professional (physician interpretation) and technica
- 50 — Bilateral procedureProcedure performed on both sides of the body during a single session.
- 51 — Multiple proceduresMultiple procedures performed at the same session.
- 52 — Reduced servicesService partially reduced or eliminated at the physician's discretion.
- 53 — Discontinued procedureProcedure discontinued because of extenuating circumstances.
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