CMS has established a GY modifier to indicate to secondary and tertiary payers a statutorily excluded service. The Centers for Medicare & Medicaid Services (CMS) has a list of statutorily excluded services or services that Medicare will not reimburse. If the GZ and GA modifiers are submitted for the same item or service, treat the item or service as having an invalid modifier and therefore unprocessable. In cases where there is no specific procedure code to describe services, a “not otherwise classified code” (NOC) must be used with either the GY or GZ modifier.Īt carrier and DMERC discretion, claims submitted using the GY modifier may be auto-denied. The GY and GZ modifiers should be used with the specific, appropriate HCPCS code when one is available. The GY modifier must be used when physicians, practitioners, or suppliers want to indicate that the item or service is statutorily non-covered or is not a Medicare benefit. GZ – Item or service expected to be denied as not reasonable and necessary. GY – Item or service statutorily excluded or does not meet the definition of any Medicare benefit. Lines submitted as non-covered and will be denied Use only with durable medical equipment (DME) items billed on home health claims (TOBs: 32x, 33x, 34x) Medically Unnecessary Upgrade Provided instead of Non-Upgraded Item, No Charge, No ABNĬan’t be used if ABN/HHABN is required, COPs may require notice, recommend documenting records beneficiary liable
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