GZ

Overview

Modifier GZ indicates that the provider expects the service to be denied by Medicare as not reasonable and necessary, AND that no ABN was obtained from the beneficiary. The provider therefore cannot bill the beneficiary if Medicare denies. GZ-bearing claims are automatically denied; their primary purpose is for the provider to record that the service was rendered without expectation of payment, often to maintain accurate utilization data and protect against false claims liability.

When to use

• The provider expects denial as not reasonable and necessary.
• No ABN was issued, so the beneficiary cannot be billed for the service.
• The provider needs to record the claim for utilization or compliance reasons despite the expected denial.

Common mistakes

• Using GZ when an ABN was actually issued — that should be GA.
• Billing the beneficiary after a GZ-denied claim — that is prohibited and can trigger compliance enforcement.

Examples

• E0850-GZ — Traction equipment provided without an ABN in a situation where the supplier expects medical-necessity denial; the supplier will absorb the cost.