Quick Facts

Status

GY

Modifier GY

Item or Service Statutorily Excluded or Not a Medicare Benefit

Active

Global Period

Not Applicable

Modifier

GY

Applies To

Statutorily Excluded Services

Category

Use With

Medicare

CPT & HCPCS Codes

What is Modifier GY?

Modifier GY indicates that an item or service is statutorily excluded from Medicare coverage or does not meet the definition of a Medicare benefit. Because the service is never covered under the applicable Medicare benefit, a mandatory ABN is generally not required.

Modifier GY allows the claim to be processed as a noncovered service and may be used when an official Medicare denial is needed for secondary insurance or other billing purposes.

When to Use

  • The service is excluded from Medicare coverage by statute.

  • The item or service does not qualify as a Medicare benefit.

  • An official Medicare denial is required.

  • A secondary insurer requires Medicare to process the claim first.

  • The service is noncovered for reasons other than medical necessity.

Documentation Requirements

  • Document the service provided.

  • Explain why the service was performed.

  • Maintain the applicable order when required.

  • Support the code reported on the claim.

  • Retain any voluntary notice issued to the patient.

Examples
Example 1

A patient receives a service that Medicare excludes by statute. The provider reports Modifier GY so Medicare can process the claim as noncovered.

Example 2

A secondary insurer requires a Medicare denial before considering payment for a service that is not a Medicare benefit. The provider submits the service with Modifier GY.

Billing Tips

  • Use GY only for services Medicare does not cover by statute or benefit category.

  • A mandatory ABN is generally not required.

  • Pair GY with GX when a voluntary notice was issued.

  • Do not use GY for services expected to be denied only because they lack medical necessity.

  • Confirm that the service is truly excluded before submitting the claim.

Common Billing Mistakes

  • Using GY for a medical-necessity denial.

  • Reporting GY for a service Medicare may cover under certain conditions.

  • Confusing GY with GA or GZ.

  • Failing to support the service in the medical record.

  • Using GX and GY incorrectly.

Related Modifiers
Modifier GA

Waiver of Liability Statement Issued

Modifier GX

Voluntary Notice of Liability Issued

Modifier GZ

Expected Denial Without an ABN

Additional Resources

CPTCodeGuide provides a concise reference for Modifier GY. For detailed Medicare billing guidance, documentation requirements, examples, denial scenarios, and modifier comparisons, visit ModifierLookup.com for the complete Modifier GY guide.