All PlansAdministrativeMedium impact
PAP248 - CPT Modifiers, GA, GX, GY or GZ - Clarification GA modifier cost share
Blue Cross of Idaho·ID·Coding
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho clarified that when GA modifiers are used for surprise billing scenarios, members only pay their in-network cost sharing amounts with no balance billing allowed. This specifically affects out-of-network providers at in-network facilities who must obtain signed Surprise Billing Protection Form consent.
Action Required
Immediately: Billing team must update procedures for GA modifier usage in surprise billing scenarios. Ensure out-of-network providers at in-network facilities obtain signed Surprise Billing Protection Form consent before services. Update billing system to process GA modifier claims with in-network cost sharing only (no balance billing) when surprise billing criteria are met. Review PAP303 - Surprise Billing policy for complete implementation guidelines.