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Modifier GY Fact Sheet

Definition

  • 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.

Modifier GY Sample

Appropriate Usage

  • 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.

Inappropriate Usage

  • Do not use on bundled procedures.
  • Do not use on add on codes

Page Last Updated: Tuesday, 15-Jul-2014 09:21:18 CDT