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New Modifiers for Noncovered Services and Services Not Reasonable and NecessaryTwo new modifiers have been implemented for services that physicians believe to be noncovered and for services that may not be reasonable or necessary for the patient's medical condition. Noncovered services are those that the Centers for Medicare and Medicaid Services (CMS) have designated to be statutorily excluded or do not meet the definition of any Medicare benefit. GY is a new modifier to be appended to the service code when the physician needs to indicate that the service is not part of the Medicare benefit, and will not be reimbursed by the program. The unlisted CPT code at the close of each specialty chapter should be used to indicate the service performed, if a specific procedure code is not available to describe the service. Example GZ is a new modifier to be appended to the service code for services that may not be reasonable or necessary, and an Advanced Beneficiary Notice (ABN) has NOT been obtained from the patient. The unlisted CPT code, ending in 99,~ at the close of each specialty chapter should be used to indicate the service performed, if a specific procedure code is not available to describe the service. Example Do not use both the GY and the GZ modifiers on the same procedural code line item. The claim will be considered unprocessable. The GA modifier remains in effect for those services that may not be reasonable and necessary when an Advanced Beneficiary Notice (ABN) HAS been obtained from the patient. Example
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