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Coding tip: Code modifier -GY to indicate a non-covered service

Ambulatory Surgery Reimbursement Update, September 4, 2007

Be aware that the AMA's verbiage has changed for modifier -GY effective July 1. Prior to July, the AMA stated that modifier -GY is to be used when providers need to indicate that the item or service they are billing is statutorily non-covered or is not a Medicare benefit.

However, as of July 1, the description states that you should use the modifier should when physicians, practitioners, or suppliers want to indicate that an item or service is statutorily excluded, does not meet the definition of any Medicare benefit or for Non-Medicare insurers, and is not a contract benefit.

Use this modifier when billing for a service that you know that payers do not cover. The fluoroscope is a great example of this. Medicare does not cover fluroscopic guidance, but if you want to bill all patients for the procedure, for example, you would bill Medicare for this in the following manner:

• Report code 77003-GY-TC. This lets the payer (Medicare, in this case) know that you are aware they do not cover this service, and you expect a denial.

This tip is brought to you by Ellis Medical Consulting, Inc.

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