GY - JE Part A

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

• CMS Internet Only Manual (IOM), Medicare Claims Process Manual, Publication 100-04, Chapter 1, section 60.4.2