Wednesday, July 27, 2016

Non covered Modifier list


HCPCS Modifiers Not Covered or Not Payable by Medicare by HCPCS Definition


-A1 through -A9,
-GY, -GZ, -H9,
-HA through -HZ,
-SA through -SE,
-SH, -SJ, -SK, -SL,
-ST, -SU, -SV, -SY, -TD through -TR, -TT through -TW, -U1 through -U9, -UA through –UD, –UF through -UK

Institutional standard systems will deny all line items on all TOBs using these modifiers in all cases as part of processing claims; provider liability is assumed EXCEPT when noted as beneficiary liable in accordance with the chart below (of the total set to the left:-GY)




Modifiers Used in Billing Ambulance Non-covered Charges

-GY, -QL, -QM* or -QN*, -TQ, alpha origin/destination modifiers*

Applicable TOBs for ambulance billing: 12x, 13x, 22x, 23x, 83x, 85x



Specific HCPCS Modifiers to Consider Related to Non-covered Charges or ABNs

-EY, -GA, -GK, -GL, -GY, -GZ, -KB,

Institutional standard systems accept some of these modifiers for processing as specified on the chart below

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