Medicare Claims Processing Manual (Pub. 100-04), Ch. 5 § 40.6
Non-covered Charge Reporting
40.6 - Non-covered Charge Reporting
(Rev. 1921, Issued: 02-19-10, Effective: 04-01-10, Implementation: 04-05-10)
Institutional outpatient therapy claims may report non-covered charges when appropriate
according to the instructions provided in of this manual. Outpatient therapies billed as
non-covered charges are not counted toward the financial limitation described above,
when that limitation is in effect, unless the charges are subject to review after they are
submitted and found to be covered by Medicare. Modifiers associated with non-covered
charges that are presented in Chapter 1, section 60 can be used on claim lines for therapy
services, in addition to the use of modifiers -GN, -GO and -GP.