I have a question regarding the hot/cold packs used in PT. I understand that Medicare considers them to be inclusive to the procedure. What I'd like to know is this, if they are considered to be inclusive to the service, do I still count them in the total time? Can I bill them with the GY modifier. My supervisor wants them billed out with the GY modifier to Medicare. The reason being this, "we can't bill some insurers and not others, if we bill them out we need to bill everyone or no one and some commercial insurers may pay". We bill them to WC without a problem and I understand that everything is different in WC. Thanks so much for your help.