DentalWriter Forum

Your central resource for DentalWriter posts, blogs, training resources, faq's, and more.

Notification

Icon
Error

Post Reply
AODTC
#1 Posted : Wednesday, June 27, 2018 12:22:09 PM(UTC)
Quote
AODTC

Rank: New Member

Joined: 9/26/2017(UTC)
Posts: 1

Hi,
What is the modifier that I use with E0486 NU to indicate that a Medicare patient is requesting a non-Medicare approved appliance? (like a dorsal). GA is the modifier for not medically reasonable and necessary, but this doesn't seem the correct description...
:)
courtneydsnow
#2 Posted : Wednesday, June 27, 2018 2:28:41 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,732

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi AODTC!

Great question. Actually, the Medicare LCD states that if an appliance used that is not PDAC cleared for E0486, instead of using HCPCS code E0486 you should code is as A9270, which stands for: Non-covered item or service

Here is the language from the LCD:

"All custom fabricated mandibular advancement devices that have not received a written PDAC Verification Review must use HCPCS code A9270 (NON-COVERED ITEM OR SERVICE)"

Hope this helps!
Guest
#3 Posted : Wednesday, June 27, 2018 3:06:13 PM(UTC)
Quote
Guest

Rank: Guest

Joined: 9/8/2012(UTC)
Posts: 1,578

Was thanked: 16 time(s) in 15 post(s)
Thank you. A biller told me to use E0486 with a modifier of GY. I guess that was incorrect?
courtneydsnow
#4 Posted : Wednesday, June 27, 2018 4:12:00 PM(UTC)
Quote
courtneydsnow

Rank: Administration

Joined: 11/21/2012(UTC)
Posts: 1,732

Thanks: 39 times
Was thanked: 51 time(s) in 51 post(s)
Hi Guest!

Well, I don't want to say that biller is incorrect, but if it were me, I would follow the Medicare LCD :)

Modifier GY stands for: GY - Item or service statutorily excluded or does not meet the definition of any Medicare benefit.
Quick Reply Show Quick Reply
Post Reply
Forum Jump  
You cannot post new topics in this forum.
You can reply to topics in this forum.
You can delete your posts in this forum.
You can edit your posts in this forum.
You cannot create polls in this forum.
You can vote in polls in this forum.