Auto Denial of Claims Submitted With a GZ Modifier

Medicare Contractors will automatically deny claim line(s) items submitted with a GZ modifier, effective for dates of service on or after July 1, 2011. Further, your Medicare contractor will not perform complex medical review on any claim line item(s) submitted with the GZ modifier.

In addition, line items denied due to the presence of the GZ modifier will reflect a Claim Adjustment Reason Code of 50 (these services are non-covered services because this is not deemed a "medical necessity" by the payer).

For more information, please refer to MLN Matters Article MM7228:
www.cms.gov/MLNMattersArticles/downloads/MM7228.pdf