Modifier GY- Item or Service Statutorily Excluded

Modifier GY is used when an item or service is statutorily excluded from Medicare coverage.

What is Modifier GY?

Modifier GY tells Medicare that a service is excluded from coverage by law and is not considered a Medicare benefit.

When to Use Modifier GY

• The service is not a Medicare benefit
• The item is statutorily excluded from coverage
• The provider expects Medicare to deny the claim
• Medicare payment is not available for the service

Billing Example

A provider furnishes a service that is not covered under Medicare benefits. Modifier GY may be appended to indicate the service is statutorily excluded.

Documentation Tips

• Verify Medicare exclusion status
• Document the service provided
• Maintain patient records
• Follow payer billing requirements

Common Denial Reasons

• Incorrect modifier usage
• Service not actually excluded
• Missing documentation
• Billing errors

Related Modifiers

Modifier GA

Modifier GX

Modifier 59