Has anyone had luck in bypassing Medicare and billing MA or PMAPS as primary for non-Medicare providers?

Tina B vor 6 Jahren in Billing/Electronic Modules aktualisiert von sarah vor 6 Jahren 7


Yes, I have success with your billing scenario. I use the GY modifier attached to your CPT codes. We have a number of clinical staff who are not associated with Medicare. Using the GY modifier will allow claims for these services to process without a denial from Medicare. We can then bypass billing Medicare and bill the secondary insurance plan successfully using the GY modifier, for example 90834 GY. 



I've also been told by a rep at MA (so I'm not sure if this also works for PMAPS) but MA has provider NPIs and names as different levels (Level 1 , Level 2 provider etc) and knows who is and isn't a Medicare eligible provider. ie. a LMFTs name and NPI can be billed to MA without a Medicare denial to MA bc MA's system knows they are not Medicare providers and rep said claims will pay. GY is another option, and might be used for other payers too. I haven't used it much.

We do not have the modifier but a waiver on file with the insurance, BCBS is one of them.

Mark, is this a specific Medicare form that you complete and put on file with the insurance company?

I too would be interested in if there is any way to bill Secondary commercial insurance and bypass billing Medicare as our providers are not able to be in-network for Medicare.  I would like to know what the process is to use the GY modifier and if paperwork is involved to be able to use it?  Thank you.

Sure would appreciate any help around this too.  We are non-enrolled with Medicare, as most of our providers are not "approved" provider types for Medicare.  Can we bill a private insurance with the GY modifier...even if client has Medicare Part B?  Or can we allow the client to do self pay?

Interested in learning more about the GY modifier and the waiver on file. Thank you both for sharing this information!