Modifiers–The Rest of the Story
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does not appear that you are trying to recoup money from
CMS on statutorily excluded services.
Patient transport, for example, is a non-covered service for
CMS and is statutorily excluded from coverage. If however,
patient transport occurs and is going to be included on the
claim form, a modifier GY should be attached to indicate
that you know it is non-covered and expect it to be denied.
Modifiers Used
in
the PQRS Initiatives
Many modifiers are utilized for a variety of circumstances
and help create a true and accurate picture of the patient.
Physicians and/or organizations participating in the Phy-
sician Quality Reporting System (PQRS), formerly the
Physician Quality Reporting Initiative (PQRI), have needs
involving a different group of modifiers. When a patient
meets the requirements of a PQRS measure but for some
reason the requirement of the initiative cannot be com-
pleted, this is also identified by use of the correct exclusion
modifier. Anytime a Performance Measure Exclusion needs
to be identified the following should be utilized:
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