Modifier GY

Definition

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

Appropriate Usage

  • Append when services are provided under statutory exclusion from Medicare Program; claim would deny whether or not modifier is present on claim
  • It is not necessary to provide patient with an ABN for these situations
  • Situations excluded based on a section of the Social Security Act
  • Non-covered ambulance mileage reported on HCPCS A0888
  • Append to cause claim to deny with patient liable for charges

Inappropriate Usage

  • Appending to bundled procedures
  • Appending to add-on codes

Resource

 

Last Updated Fri, 28 Feb 2020 13:06:38 +0000