ED Coding and Reimbursement Alert

Question: What are modifiers -GY and -GZ, and how should I use them?
   
Oregon Subscriber
 
Answer: The Centers for Medicare and Medicaid Services created modifiers -GY and -GZ in 2002, designed for use on claims for noncovered services. According to the agency, "The -GY modifier must be used when physicians, practitioners, or suppliers want to indicate that the item or service is statutorily non-covered or is not a Medicare benefit."

You should append modifier -GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit) when you know a claim will be denied because Medicare is legally forbidden to pay for one of the services. The services Medicare cannot legally cover are marked with an "N" status code on the Medicare fee schedule. For example: Coders are instructed to append modifier -GY to V5010 (Assessment for hearing aid).

Use modifier -GZ (Item or service expected to be denied as not reasonable and necessary) if your Medicare local coverage decision excludes the service as unnecessary and the physician was unable to get a signed advance beneficiary notice (ABN). Due to Emergency Medical Treatment and Labor Act rules that severely restrict the use of ABNs in an emergency-department setting, ABNs may not always be easy to obtain.