Last Modified: 7/31/2018 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, effective on June 28, 2018, all ambulance transports require a dual diagnosis.
Source: LCD L37697 - effective 06/28/2018
Please use your browser's back button to return to the referring page.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.