Modifier GY Fact Sheet
- If the service provided is statutorily excluded from the Medicare Program, the claim will deny whether or not the modifier is present on the claim.
Example: Patient transport is for a non-covered condition that does not meet the definition of any Medicare benefit. The provider is expecting a denial.
- Services provided under statutory exclusion from the Medicare Program, the claim would deny whether or not the modifier is present on the claim
- It is not necessary to provide the patient with an ABN for these situations.
- Situations excluded based on a section of the Social Security Act.
- Modifier GY will cause the claim to deny with the patient liable for the charges.
- Do not use on bundled procedures.
- Do not use on add on codes