How should a laboratory bill for services that are non-covered for reasons other than medical necessity?
Question
How should a laboratory bill for services that are non-covered for reasons other than medical necessity?
Answer
Healthcare Common Procedure Coding System (HCPCS) coding provides for a GY modifier to be used to indicate an item or service that is statutorily excluded or does not meet the definition of any Medicare benefit. The list of non-covered codes for laboratory procedures subject to the negotiated NCDs can be found in the coding manuals in the “Non-covered ICD-9-CM Codes for All NCD Edits” section. These are the only codes that should be billed with the GY modifier for services subject to the negotiated laboratory NCDs. http://www.cms.hhs.gov/ncd/labindexlist.asp
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