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Gy & gz modifiers

  1. #1
    Default Gy & gz modifiers
    Exam Training Packages
    Can someone give an example of GY and the GZ modifiers. I need some clarification on both.

    I work in a practice where services are done to pts who are eligilbe for Medicare for some reason, but the services are not a covered benefit by Medicare. eg: a 33 year female (medicare eligible) needed and x-ray for an injury, but because she child was bearing age so the x-ray falicilty requires a pregnancy test before the x-ray can be provided to the pt. (understandable)

    Also I have a provider who likes to perform labs even when we know that Medicare will not consider this "medically necessary" (the dx)

    I know we should be utilizing ABN/exclusion waiver forms, but I am the CPC not management and managment refuses to address these issues. Stuck b/w a rock and hard place.

    Thanks !

    Shaunta Brake,CPC

  2. #2
    Marion, OH
    Default Gy & qw
    You would use the GY if you know that medicare is not going to pay (eg annual exam) but the patient wants to have it done anyways. The GY modifier indicates that the patient has signed an ABN and wants the service done even though Medicare will not pay.

    We recently found out that for a urine pregnacy test you can add a -QW modifier and they will process this. I am not sure what other test you could add this too. I hope this helps some.

  3. #3
    Default Gy & gw modifier
    Thanks but why would they process a service that is not covered?

  4. Default
    Sometimes the patient may have a secondary insurance that won't process a claim without a denial from the primary insurance. Also, sometimes the patient may want "proof" from the insurance that a service isn't covered.


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