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Last Modified: 10/7/2022 Location: FL, PR, USVI Business: Part A, Part B

GY modifier and dual diagnosis requirement

Q. If an ambulance provider is purposefully submitting a claim using the GY modifier to acknowledge that the service is/will be statutorily excluded, is the dual diagnosis requirement still in effect (i.e., is there still a requirement that a secondary diagnosis via a Z-code be submitted?)
A. Although the GY modifier (defined as “item or service statutorily excluded or does not meet the definition of any Medicare benefit”) may be a determinant of claim processing, based on local coverage determination (LCD) L37697-Emergency and Non-Emergency Ground Ambulance Services external link, effective on June 28, 2018, all ambulance transports require a dual diagnosis.
Source: LCD L37697 external link - effective 06/28/2018
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