HCPCS Modifier GJ

Description
Opt-out physician or practitioner emergency or urgent service.

Guidelines/Instructions
  • Physicians that have opted out of Medicare (also called private contracting) are not permitted to submit services to Medicare; however, the exception to this rule is when services provided on an emergent or urgent basis. Opt-out physicians and practitioners must submit these services to Medicare with HCPCS modifier GJ.
  • In order to opt-out of Medicare, physicians and practitioners that are permitted to opt-out must follow certain procedures and guidelines
Reference: CMS Pub. 100-02, Chapter 15, Section 40 (PDF, 1.37 MB).

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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