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Printed Date: 9/22/2015
The claim contains a line (s) with provider submitted non-covered charges and a GL, GY, or TS modifier is present. When this code is present on an 81x or 82x TOB for revenue code 0659 with HCPCS A9270, it denotes a hospice room and board denial.
The provider has submitted non-covered charges with HCPCS modifier GL, GY or TS on an outpatient claim. The service line with HCPCS modifier GL, GY or TS is reported as non-covered to appropriately assign liability to the beneficiary for payment.
CMS Internet Only Manual (IOM), Publication 100-4, chapter 30 (PDF, 1.9 MB).
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Last Updated: 12/16/2019