GY

Overview

Modifier GY indicates the service is statutorily excluded from Medicare coverage — that is, the item or service does not meet the definition of any Medicare benefit under the Social Security Act, or for non-Medicare beneficiaries the item is not a benefit at all. Unlike GA, no ABN is required for statutorily excluded services because there is no Medicare benefit to be denied. Submitting a claim with GY produces a denial, which the beneficiary can use to bill secondary insurance.

When to use

• The service is excluded by statute (e.g., routine vision exams, hearing aids, cosmetic surgery, custodial care).
• The beneficiary needs a Medicare denial on file to pursue secondary coverage.
• No ABN is required because the exclusion is statutory, not based on medical necessity.

Common mistakes

• Using GY for services that ARE a Medicare benefit but might be denied as not medically necessary — that requires GA, not GY.
• Issuing an ABN unnecessarily; GY-bearing claims do not require ABN signature.

Examples

• V5008-GY — Hearing screening test, statutorily excluded by Medicare.
• V2020-GY — Vision exam frame; Medicare does not cover routine eyewear except after cataract surgery.