Improper Use of Modifier GY and Bundled Services

Noridian has seen a large volume of status (B) bundled CPT codes billed with the addition of modifier GY. The modifier is being incorrectly used to circumvent the financial liability of the provider to the beneficiary.

You can find the status indicator of most CPT codes on the Medicare Physician Fee Schedule (MPFS) provided in the resources at the bottom of this page.

Example of bundle (B) code listing on fee schedule:

Code Mod S GLB Pre-OP
Percent		 Intra-OP
Percent		 Post-OP
Percent		 P/T M B A C T ICI PSDP ENDO
Base
99072 blank B XXX 000000 000000 000000 9 9 9 9 9 9 9 09 blank

 

  • CPT 99072 - Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease.

CMS Status "B" or bundled service means:

  • Payment for these services always bundle into payment for other services
  • There are no RVUs, or payment amounts for these codes and no separate payment is allowed
  • Providers may not bill the beneficiary for this service
  • Issuing an Advanced Beneficiary Notice related to this service is not an option
  • Usage of the GY is for statutorily excluded services and not appropriate for bundled services

For Medicare purposes the codes with a status indicator of (B) should never be unbundled using any sort of modifier and the liability is the providers as the items and services are already part of the payment to other service(s) performed on that day and are not separately payable.

Resources:

 

Last Updated Jun 13 , 2022