New HCPCS Modifiers!
Effective January 1, 2002, two new modifiers will be recognized by Medicare.
- GY – item or service statutorily excluded or does not meet the definition of Medicare benefits.
- GZ – item or service expected to be denied as not reasonable and necessary.
The modifiers will replace the –GX modifier.
Modifier GY is for items and services never covered by Medicare such as routine physicals and cosmetic surgery. You are only billing the service with this modifier to get a denial. Carriers will be allowed to automatically deny services submitted with this modifier.
Modifier GZ is for items and services you expect to be denied due to medical necessity, such as a screening test done more frequently than allowed or a non-covered ICD-9 used. Only use this modifier if no ABN was obtained. Carriers will be allowed to automatically deny items and services with this modifier.
As before, use modifier GA when submitting a claim for a service considered not medically necessary and you have obtained an ABN. Carriers will still have to process these claims.
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