Medicare dme modifier

Valerie813

Networker
Messages
75
Location
Chicopee, Mass
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Hello,

My Tufts Medicare Preferred denied a claim for code L4360 stating I needed a modifier. I applied the LT and they still denied stating they needed an additional modifier- and told me to see Medicare Guidelines. Anyone have any answers for me???? I need someone's expertise..

Thanks!!
Valerie
 

msrd_081002

Networker
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79
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0
GY modifier (Tx/pressure ulcer)

Hello,

My Tufts Medicare Preferred denied a claim for code L4360 stating I needed a modifier. I applied the LT and they still denied stating they needed an additional modifier- and told me to see Medicare Guidelines. Anyone have any answers for me???? I need someone's expertise..

Thanks!!
Valerie
---------
It is GY modifier.

If a walking boot L4360 is used solely for the prevention or treatment of a pressure ulcer, the GY modifier must be added to the base code and to the code for the replacement liner (L4392, L4394).
When the GY modifier is added to a code there must be a short narrative statement indicating why the GY modifier was used – e.g., “used to prevent pressure ulcer” or “used to treat pressure ulcer” or “used to treat edema”. This statement should be entered in the narrative field of an electronic claim or attached to a hard copy claim.


Thanks
 
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