Wiki Is an abn necessary when appending gy mod.

[sandra mitchell]

When appending a GY modifier to a Medicare out patient procedure, is it necessary to obtain an ABN in order to bill the patient?

 

[PLAIDMAN]

From what I understand

No you do not require an ABN if you are applying a GY, GY is statutorily excluded as a non covered benefit, so you already know it is NOT covered, there would be no reason for the ABN, which states Medicare "may" not cover items or services.

I actually am in discussion with my state medical society to get an answer on this problem, because Medicare does not want you to bill them for non covered items or services EVEN for the purposes of getting a denial- so why did they create the GY????

Also I can't really think of an outpatient procedure you would want to apply that to???Curious???

Anywhoooo, the answer would be no.

 

[sandra mitchell]

The procedure is 76390 (26) (GY) and the EOB came back with a PR56, so our system billed the patient.