Which modifier indicates that the treatment is most likely not covered by Medicare, and the patient signed an ABN?

• A. That the treatment is not covered by Medicare
• B. Voluntary ABN used for service
• C. Active treatment
• D. The treatment is most likely not covered by Medicare, but the patient signed an ABN

Answer: (D)

The key idea is the Advanced Beneficiary Notice (ABN) and how it relates to Medicare coverage. An ABN is given to a patient when there’s a reasonable expectation that Medicare may not cover a service, so the patient can decide whether to proceed and accept responsibility for payment if Medicare denies it. When the patient signs the ABN, the provider is allowed to bill the patient directly for that service if Medicare does deny it.

Among the options, the one that best reflects both elements—the service being potentially not covered and the patient having signed an ABN—is the statement that explicitly pairs non-coverage with an ABN signed by the patient. That ties together the payer's likely denial with the patient’s consent to be billed. The other choices either mention the ABN without linking it to non-coverage or refer to non-coverage or the service in a way that doesn’t involve the ABN signing requirement, or are unrelated to Medicare billing.

In practice, when an ABN is on file for a service that Medicare may not cover, a modifier like GA is used on the claim line to show that the ABN was signed. If the ABN isn’t obtained, a different modifier (GZ) is used to indicate the service is expected not to be covered.