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Last Modified: 12/3/2017 Location: FL, PR, USVI Business: Part A, Part B

Restricted modifiers and procedure codes FAQ

Q. I submitted a claim and applied the GY modifier in error. Can I use SPOT to reopen and correct the claim?
A. Modifier GY (item or service statutorily excluded or does not meet the definition of any Medicare benefit) may not be corrected through SPOT. In fact, due to their nature, there are several modifiers and procedure codes in which claims may not be corrected through SPOT.
Modifiers that cannot be corrected in SPOT include:
21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, WU
CPT/HCPCS that may not be corrected using SPOT include:
J0200, J0390, J0395, J0520, J0735, J1094, J1700, J1710, J1885, J1960, J1990, J2323, J2440, J2670, J2760, J3490, J3590, J7130, J7184, J7199, J7310, J7326, J7628, J7629, J7648, J7658, J7659, J7683, J7684, J8499, J9165, J9201, J9217, J9219, J9270, J9357, J9999, Q0144, Q2027, Q2034, Q2035, Q2036 Q2037, Q2038, Q2039, Q2045, Q2046, 90654, 90655, 90656, 90657, 90658, 90659, 90660, 90667, 90668, 90715, 90724, 90779, 96549
If your claim includes any of the modifiers or procedure codes listed above, you may submit a request for redetermination through the mail using the applicable form pdf file.
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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.