GY - JE Part B

Definition

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

Correct Use

• Append when services are provided under statutory exclusion from Medicare Program; claim will deny if modifier is present on claim or not
• 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

Incorrect Use

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

Resource

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