![]() In cases where there is no specific procedure code to describe items or supplies, an NOC must be used with either the GY or GZ modifiers.Įffective January 1, 2002, the A9270, Noncovered item or service, under no circumstances will be accepted for services or items billed to local carriers. The GY and GZ modifiers should be used with the specific, appropriate HCPCS code when one is available. The GA modifier must be used when suppliers want to indicate that they expect that Medicare will deny an item or supply as not reasonable and necessary and they do have on file an ABN signed by the beneficiary. The GZ modifier must be used when suppliers want to indicate that they expect that Medicare will deny an item or supply as not reasonable and necessary and they have not had an Advance Beneficiary Notification (ABN) signed by the beneficiary. ![]() ![]() The GY modifier must be used when suppliers want to indicate that the item or supply is statutorily noncovered or is not a Medicare benefit. Use of the GA, GY, and GZ Modifiers for Items and Supplies Billed to DMERCs In cases where there is no specific procedure code to describe services, a “not otherwise classified code” (NOC) must be used with either the GY or GZ modifier.ģ. (See for additional information on use of the GA modifier and ABNs.) The GA modifier must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny a service as not reasonable and necessary and they do have on file an ABN signed by the beneficiary. The GZ modifier must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an Advance Beneficiary Notification (ABN) signed by the beneficiary. 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. ![]() Use of the GA, GY, and GZ Modifiers for Services Billed to Local Carriers GZ – Item or service expected to be denied as not reasonable and necessary.Ģ. GY – Item or service statutorily excluded or does not meet the definition of any Medicare benefit. GA – Waiver of liability statement on file. Definitions of the GA, GY, and GZ Modifiers ![]()
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