GY Modifier

Laura G 4 months ago in Billing/Electronic Modules updated by akeller 3 months ago 1

We are skipping Medicare for an unlicensed therapist, adding a GY modifier, and sending it to MA/PMA. (FIRST, skipping Medicare)  MA/PMAP denying due to billed to wrong insurance (Not Primary). Medicare denies for Unlicensed therapists. Please help me what are we doing incorrectly?

Hi Laura,

What is the licensure of the clinician that the unlicensed therapist is billing under? I've found that if the supervisor is a Medicare-eligible provider (LICSW or LP), it confuses the secondary plan and get those denials. If the supervisor is not Medicare-eligible (LMFT/LPCC), I haven't had any issues billing straight to secondary without the GY modifier - I think they must recognize the licensure associated with the NPI#.

Hopefully that helps!