GY - JA DME

Item or service statutorily excluded or does not meet the definition of any Medicare benefit

Statutorily Excluded Examples (not all-inclusive)

• Hearing aids
• Most dental items
• Personal comfort items

Does Not Meet Definition of Medicare Benefit Examples (not all-inclusive)

• Prosthetic device for temporary conditions
• Immunosuppressive drugs used for conditions other than following Medicare covered transplant
• DME used only outside home

Correct Use

• Use to obtain a denial on a non covered service
• Use to notify Medicare that you know this service is excluded
• Append to get beneficiary-liable denial