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Q: How do I obtain a denial from Medicare for a claim when the secondary payer requires one?

A: The “-GY” modifier should be appended to the CPT code to indicate an item or service that is statutorily excluded or does not meet the definition of any Medicare benefit. This is the code to use when seeking a “denial” for secondary purposes. Providers are mandated under the Medicare program to issue an Advance Beneficiary Notice (ABN) to patients if there is a reason to expect a reasonable and medically necessary denial.

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