Billing for Medicare primary members correct use of the GY modifier

In October, Anthem Blue Cross implemented new guidelines to help reduce the administrative work associated with Medicare crossover claims filing. CMS has a list of statutorily excluded services or services that Medicare will not reimburse. CMS has established a GY modifier to indicate to secondary and tertiary payers a statutorily excluded service. While Medicare never covers statutorily excluded services, in some instances, a secondary payer, such as Anthem Blue Cross, may cover all or a portion of those services. To expedite payment when submitting a claim for statutorily excluded services, only services with the GY modifier should be submitted on the claim. If other non-statutorily excluded services are rendered, those services should be split off the claim and submitted on a separate claim. If providers submit combined line claims (some lines with the GY modifier, some without) to their local plan, the provider’s local plan will deny the claims, instructing the provider to split the claim and resubmit.