GY Modifier – Definition and Example of How to Use

What is a Modifier?

A coding modifier is sometimes used when billing health insurance companies. It provides extra information about the procedure code being used, without altering the definition of the code. 

If billing on a CMS1500 form, modifiers go in box 24D, next to the CPT code. There is space available for up to four modifiers.

GY Modifier Definition

The GY modifier is defined as, “item or service statutorily excluded or does not meet the definition of any Medicare benefit.”

When to Use the GY Modifier

The GY modifier can be used when a Medicare beneficiary is receiving a service that Medicare statutorily excludes, or does not meet the definition of a Medicare benefit.

In this situation, the patient does not need to fill out an Advance Beneficiary Notice (ABN) to be financially liable.

This modifier can be combined with the GX modifier.

Example of When and How to Use the GY Modifier

Medicare does not cover hearing aids as it statutorily excluded. The supplier can send a claim to Medicare using the GY modifier so the claim can be denied as patient liability, rather than provider liability, using the GY modifier. 

If the patient has coverage for hearing aids through a secondary insurance, that insurance plan will now be able to pay the claim. The patient does not need to fill out an ABN during this process. 

Other ABN Claim Reporting Modifiers

  • GA Modifier –  “Waiver of Liability Statement Issued, as Required by Payer Policy”
  • GZ Modifier – “Item or Service Expected to Be Denied as Not Reasonable and Necessary”
  • GX Modifier – “Notice of Liability Issued, Voluntary Under Payer Policy”

References:

CPT 2021 Professional Edition

What are medical coding modifiers

Medicare Advance Written Notices of Non-Coverage

Memorandum Report: Medicare Payments for Part B Claim with G Modifiers

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