Bypass Medicare and Bill PMAP for Residential Substance Abuse

Jackie Waara 3 years ago in Payers Module updated by Jen 3 years ago 2

Hi! I am brand new to Residential billing. I have a Residential SUD Facility that is not JCAHO or CARF certified. I have a patient who has Medicare as primary and UCare PMAP as secondary.  For SUD OP services we bypass Medicare and bill Ucare as primary.  Does anyone know if I can do that with Residential SUD as well? Or do all patients who have Medicare as primary have to go to a JCAHO/CARF facility? 


For Residential and IOP SUD services we have not had a problem billing the PMAP's directly as primary. 

Good Morning, when billing for SUD Services for clients with Dual PMAP plans we bill the PMAP directly adding a GY Modifier to the claim.  Only add it to the treatment line not the room and board.

Found this online- GY - Item or service statutorily excluded or does not meet the definition of any Medicare benefit. ... The GY modifier must be used when physicians, practitioners, or suppliers want to indicate that the item or service is statutorily non-covered or is not a Medicare benefit.