Question: Nebraska Subscriber Answer: Therefore, you are not required to obtain the ABN, but you may want to consider voluntarily doing this as a means of notifying the patient of non-coverage and financial responsibility. You are also not required to submit the non-covered service to Medicare unless the patient requests this to be done for the purpose of obtaining a denial for a secondary insurance or does not believe the service in non-covered. You need to append modifier GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit) to the non-covered code when you submit the claim. When is it mandatory to provide an ABN to a Medicare beneficiary? CMS requires a provider to notify a beneficiary in advance when he or she believes that items or services will likely be denied either as not reasonable and necessary or as constituting custodial care.