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June 8, 2023
Clarification for billing with a GY modifier when Medicare is the primary insurance.
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Effective for dates of service beginning August 1, 2023, services covered by Medicare must be provided by a Medicare-enrolled provider and billed to Medicare first.
Effective for dates of service beginning August 1, 2023, Hennepin Health will apply all coordination of benefits rules. It is the provider’s responsibility to verify member eligibility and primary coverage before providing services, and to follow primary payor requirements. Services covered by Medicare must be provided by a Medicare-enrolled provider and billed to Medicare first. The GY modifier should only be used for an item or service that is statutorily excluded or does not meet the definition of any Medicare benefit. The GY modifier is only to be used when the service is never covered by Medicare.
For dates of service starting August 1, 2023, Hennepin Health will deny services received where the GY modifier is appended to the procedure code and the procedure code is a Medicare covered benefit. Claims will be denied with an explanation of benefits code (CO-22) indicating that other insurance is primary.