Program_Memos / 2002 / B-02-020

Why This Topic Matters

It helps readers understand a Medicare program update that changed how certain non-covered or denied services were represented on claims and how related HCPCS identifiers were handled. The memo is relevant to billing staff, coders, suppliers, and compliance teams working with Medicare claims in the 2002 timeframe.

Article Sections

1. Purpose and background

   Introduces the memorandum, its CMS context, and the relationship to the prior transmittal and change request. It also notes the effective timing and replacement status of earlier guidance.

2. Discontinued codes and modifier

   Lists identifiers that were discontinued or superseded and identifies the associated update context. The section frames the transition from prior coding references to the new approach.

3. New modifiers

   Introduces newly issued modifier identifiers and explains that they were added for Medicare claim reporting. The section situates the changes within the annual HCPCS update.

4. Clarification on use of A9270

   Addresses the status of a specific HCPCS code and its continued role in Medicare billing. It also notes a processing-file limitation tied to a supplier category.

5. Use of the GA, GY, and GZ modifiers for services billed to carriers

   Describes how the Medicare claim environment distinguishes among the new and existing modifiers for carrier-submitted services. It also discusses the relationship to specific HCPCS codes and to claims lacking a specific procedure code.

6. Use of the GA, GY, and GZ modifiers for items and supplies billed to DMERCs

   Covers the same modifier framework as applied to DMERC billing for items and supplies. The section also addresses fallback coding situations when no specific procedure code is available.

7. Carriers and DMERCs

   Summarizes claim-processing handling for the modifiers in the carrier and DMERC settings. It includes administrative treatment of invalid modifier combinations.

8. Explanatory information to be included on claims

   Outlines the documentation and narrative placement requirements associated with certain claim submissions. It references paper and electronic claim formats and supplemental narrative handling.

9. Provider notification

   Provides instructions for communicating the update to providers and suppliers through routine channels. It closes with effective and discard dates for the memorandum.