Modifier GY

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

 

Last Updated May 07, 2018