The GY, GA, and GZ Modifiers for Medicare

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Answer

That is a GY modifier. This is another one where I recommend going to the Medicare website, because GY is one of a couple of different modifiers you need to know about.

There's a GA modifier for letting Medicare know that the patient has signed an advanced beneficiary notification. There is a GY modifier, when you know it's going to be denied, but it serves a purpose. There is also a GZ modifier. So go to www.cms.hhs.gov, and in the search box, type in "GY modifier" because when you find that, you'll typically find the documentation for the other modifiers as well.

And so, on your CMS-1500 form, there is a box there for modifiers, and you'll simply put in "GY." This tells Medicare, "I know this is statutorily denied, but I need to have you deny this claim so another third-party payer covering this patient will pay for the service." And Medicare's fine with that.

GY modifier may also be used when the patient's secondary insurance depends on a Medicare denial. Most claims submitted with a GY modifier will be denied automatically by the carrier or a fiscal intermediary. With these cases, a beneficiary will be liable for the charges. And that's an important statement for you to know.


Robert Fifer, Ph.D., is the Director of Audiology and Speech-Language Pathology for the Mailman Center for Child Development at the University of Miami School of Medicine. He is also an Audiology Online Contributing Editor in the area of Coding and Billing. He is the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee.

Editor's Note - The above is a partial transcript from the Coding and Billing QNA Live e-Seminar that was conducted on Audiology Online on June 27, 2007. (The recorded version is available here - Also the complete edited transcript is available here. The format of the session was different from most traditional presentations as we solicited questions ahead of time and also solicited questions during the event and had Dr. Fifer focus on answering those questions during the live session. We have published the transcript from the seminar in a semi-rough format to preserve the live feel from the session and to accelerate the publication timeline of this information to the Audiology Online readers. Submitted questions are bolded, followed by Dr. Fifer's response. Dr. Fifer is a frequent Contributing Editor for Audiology Online in this area, look for additional Coding and Billing QNA sessions on our home page in the near future. - Paul Dybala, Ph.D. - Editor