GY modifier

"Item or service statutorily excluded or does not meet the definition of any Medicare benefit."
Description When to use the Examples of its use What happens if you What happens if you don't use the
GY modifier use the GY modifier? GY modifier?
These are the so- 1) When you think a 1) Routine physicals, The claim will be denied The claim will be reviewed by
called "statutory claim will be denied laboratory tests in by Medicare. The carrier Medicare and probably will be
exclusions" or because it is not a absence of signs or may "auto-deny" claims denied. This action may be slower
"categorical Medicare benefit or symptoms, hearing with the GY modifier. than if you had used a GY modifier.
exclusions" and because Medicare law aids, air conditioners, This action may be
the "technical denials." specifically excludes it. services in a foreign quicker than if you do not If the claim is denied as an excluded
country, services to a use a GY modifier. service or for failure to meet the
ABNs are not an issue 2) When you think a family member. definition of a benefit, the beneficiary
for these services. claim will be denied The beneficiary will be will be liable for all charges, whether
because the service 2) Surgery performed liable for all charges, personally or through other
There are no advance does not meet all the by a physician not whether personally or insurance.
beneficiary notice requirements of the legally authorized to through other insurance.
(ABN) requirements for definition of a benefit in perform surgery in
statutory exclusions. Medicare law. the State. If Medicare pays the
claim, the GY modifier is
There are no ABN 3) When you submit a irrelevant.
requirements for claim to obtain a
technical denials Medicare denial for
(except three types of secondary payer
DMEPOS denials, and purposes.
they are listed under
modifiers GZ & GA).