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CMS Transmittals




CodeMap Compliance Briefing: 11/07/03: Important Modifiers

Editor's Welcome:

On October 24, 2003, CMS published a transmittal instructing carriers and fiscal intermediaries to recognize the GY modifier by January 1, 2004. All Medicare providers should understand the proper use of the GY modifier as well as the GA and GZ modifiers. All three modifiers relate to medical necessity, coverage, and ABN issues. This week we describe the appropriate use of these coding modifiers. As always feel free to forward comments, questions, and suggestions for future CodeMap Compliance Briefings. We will do our best to answer all emails.

Sincerely,

Gregory Root, Esq.

The GY Modifier

Medicare providers should use the GY modifier on claims that the provider knows or thinks will be denied because the test or service is clearly not covered. Examples of clearly non-covered services include routine physicals, many screening tests, hearing aids, and any other services statutorily excluded by federal law.

The GY modifier may be used by a provider when the patient....

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