Do chiropractors use GP modifiers?
Asked by: Rosamond Bosco | Last update: March 11, 2025Score: 4.6/5 (40 votes)
What modifiers do chiropractors use?
Chiropractic modifiers can be attached to certain CPT codes to tell insurance companies that there is something different about the services related to the CPT code being billed. While there are several modifiers, the two most commonly used in modifiers by chiropractors are modifier 25 and modifier 59.
When should GP modifier be used?
Use a GP modifier in any case where there could be confusion as to which provider delivered services to a patient, such as in any interdisciplinary therapy setting.
What insurances require a GP modifier?
These plans include Blue Cross Blue Shield of Michigan, Blue Cross of California (Note: This does not include Blue Shield of California), BCBS plans of Indiana, Kentucky, Missouri, New Jersey, New York (Empire), Ohio, Vermont, and Wisconsin. (*Note: If it is an Anthem policy there will also be a need for modifier GP.
Does 97110 need a modifier for chiropractic?
Does 97110 need a 59 modifier? The 59 modifier is an essential component when billing with the 97110 CPT code. This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day.
Chiropractic modifiers can be so confusing!!! What to use... 2023
Can a chiropractor use a GP modifier?
So if you render and bill for 1-2 regions of CMT (98940) and therapeutic exercise (97110), then the 97110 chiropractic CPT code will receive the GP modifier.
Does CPT 97140 need a GP modifier?
Here are some common modifiers used with 97140 and when to apply them: Always Therapy Modifiers: GP: This modifier indicates that the services were provided by a physical therapist. It's required for Medicare claims and often used by other payers as well.
What is the difference between GP and go modifier?
Specialty Specific Modifiers
Modifier GO – Services delivered under an outpatient occupational therapy plan of care. Modifier GP – Services delivered under an outpatient physical therapy plan of care.
Can 97110 and 97140 be billed together?
Since the time for each service is the same, choose either code for 2 units and bill the other for 1 unit. Do not bill 3 units for either one of the codes. Appropriate billing for 40 minutes is for 3 units. Bill 2 units of 97110 and 1 unit of 97140.
Do I need a modifier for 99214?
Does 99214 need a modifier? Modifiers can be used with 99214 if applicable. For example, you can add Modifier 25 to the E/M visit with 99214 if there was a “separately identifiable E/M on the same day of a procedure” (source: ACC). Or add modifier 22 if the procedure was extra complex.
What is the modifier for massage therapy?
Essential Modifiers for Massage Therapy CPT Codes
Modifier 59: This modifier for massage therapy CPT codes indicates that two separate but similar procedures were performed on the client within the same day or time span of a few days.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is modifier GP 59?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services. FACT SHEET.
What is the modifier 25 for chiropractors?
Modifier 25 is used to signify that when a separate identifiable evaluation-and-management (E/M) service was performed, which can refer to two evaluation-and-management (E/M) services, or a procedure plus an E/M service.
What is the 51 modifier for chiropractic?
The Modifier 51 is to be used for “Multiple Procedures” that are related, where the secondary procedure is less integral than the primary. This does not apply to chiropractic adjustment coding.
Can a chiropractor bill CPT code 97140?
Regarding the 97140 Chiropractic CPT Code modifiers, many insurance companies will “reimburse for the 97140 code” if billed with a '59' modifier. Use the 59 modifier (distinct procedural service) with the chiropractic CPT code 97140 when you perform manual therapy during the same encounter as a chiropractic adjustment.
What is chiropractic billing code 97110?
CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.
What are the three types of NCCi edits?
NCCI includes three types of edits: NCCI procedure-to-procedure (PTP) edits, medically unlikely edits (MUEs), and add-on code edits.
What does mue stand for in medical coding?
National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), to reduce improper payments for Part B claims.
When to add GP modifier?
Every service performed by a physical therapist (PT), occupational therapist (OT), or speech-language pathologist (SLP) requires a therapy modifier (GP, GO, GN) for claim submission. So in this scenario, you would affix the GP modifier to the claim.
Does 97110 need a GP modifier?
If a physical therapist provides, say, therapeutic exercise, they might use the CPT code 97110. As therapeutic exercise would likely fall within the patient's physical therapy plan of care, the modifier would be added to the code, so it reads “97110-GP.” It's that simple.
When to use GV and GW modifier?
The GV and GW modifiers are used for Medicare hospice patients. The GV modifier is used to report services related to a patient's hospice care, while the GW modifier is used to report services that are unrelated to the patient's hospice care.
Can chiropractors bill physical therapy codes?
The chiropractic physician can only bill under the codes 98940-43. Our chiropractor is licensed to perform Physical Therapy in this state(although he is not a "Licensed Physical Therapist"). He can and does bill out PT codes when/if he performs physical therapy services.
What is CPT code 98940 for chiropractic?
CPT® 98940, Under Chiropractic Manipulative Treatment Procedures. The Current Procedural Terminology (CPT®) code 98940 as maintained by American Medical Association, is a medical procedural code under the range - Chiropractic Manipulative Treatment Procedures.
What insurance companies require the GP modifier?
The use of the GP modifier is required now on all claims to United Health Care and their affiliates, VA claims, Medicare claims, Blue Cross Blue Shield of Michigan and now Anthem Blue Cross of California.