GY Modifier
There are 4 modifiers to be used with Medicare procedures that may be denied due to medical necessity or because of non-coverage. They all cause the claim to be denied quickly, and they could then be sent to secondary coverage. Most of the Medicare supplemental policies may not automatically pay if they contain the phrase "If Medicare denies, we deny" when verifying coverage.
GY - ABN (Advance Beneficiary Notice) not required. You provide a service that is noncovered/excluded. Depending on coverage, supplement or secondary may cover, or you can bill patient.
GX - You provide an excluded service and execute a Voluntary ABN. Depending on coverage, supplement or secondary may cover, or you can bill patient.
GA- Mandatory ABN on file. You expect the service to be denied based on lack of medical necessity and you have a signed ABN on file for the service. Depending on coverage, supplement or secondary may cover, or you can bill patient.
GZ- I refer to this as "got zilch". You think a service will be denied as not medically necessary and you do not have an ABN signed. If only Medicare coverage, you CANNOT bill patient (you got zilch).
Hope this helps.
Diane Muchow, CPC