Does 97110 need a GP modifier?
Asked by: Kathlyn Schamberger | Last update: July 9, 2025Score: 4.6/5 (48 votes)
Does CPT code 97110 need a GP modifier?
Answer: The GP modifier is used to indicate that the services provided are part of an outpatient physical therapy plan of care. You should attach the GP modifier to CPT 97110 when billing for therapeutic exercises in an outpatient setting, which helps payers easily interpret the treatment as physical therapy-related.
When should a 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 documentation is needed for 97110?
Documentation should include not only measurable indicators such as functional loss of joint motion or muscle strength, but also information on the impact of these limitations on the patient's life and how improvement in one or more of these measures leads to improved function.
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.
Physical Therapy 97530 and 97110 - Medical Coding
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.
What is the difference between go and GP modifier?
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 you bill 2 units of 97110?
The Codes. Per the Medicare 8-minute rule, it would be appropriate to bill Medicare in one of these three ways: two units of 97110 (therapeutic exercise), one unit of 97112 (neuromuscular reeducation), and one unit of 97116 (gait training) two units of 97110 and two units of 97116.
What is the difference between 97140 and 97110?
CPT code 97140 is used for skilled manual therapy techniques with no additional activities simultaneously occurring. If therapeutic, resistive, or strengthening exercises are included in combination with manual techniques, these activities fall under CPT code 97110, therapeutic exercise.
What is the modifier for physical therapy insurance?
The GP Modifier is most often employed in inpatient and outpatient situations. It shows a service or treatment within a physical therapy care plan. Applying the GP modifier on the precise line item denotes that an authorized physical therapist performed this service.
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.
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.
How much does Medicare pay for 97110?
Therapeutic exercise (97110) will drop by an average of 3.3%, going from $31.40 to $30.36. Manual therapy (97140) sees a similar percentage decrease, from $28.87 to $27.91.
What is the difference between CPT code 97110 and 97530?
The major difference between CPT 97110 and 97530 is the number of target areas being addressed during the activity. 97530 CPT code most frequently focuses on two or more areas.
What modifier is needed for 97110?
Modifiers GP(Outpatient Physical Therapy), GO (Outpatient Occupational Therapy), GN (Outpatient Speech-Language Pathology), CO (Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)), CQ (Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)), ...
What is 97110 gp?
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.
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.
How to document 97110?
For CPT 97110 documentation, be sure to provide information regarding volume of exercise. That means documenting the number of sets and repetitions, amount of resistance (weight, force, torque), and duration of holds. You should also document how you determined the resistance.
Can modifier 50 be billed with 2 units?
"Modifier -50 should be used for bilateral procedures. Bilateral procedures should be listed on the claim as a single line item, with modifier -50, and a two in the units field."
Can a massage therapist bill 97110?
97110 Therapeutic Exercise
This code describes exercises that develop strength, endurance, and flexibility facilitated by a licensed healthcare provider. Massage therapists don't typically qualify as an appropriate provider of this service.
Does UnitedHealthcare require GP modifier?
Effective with dates of service on or after July 1, 2020, UnitedHealthcare aligns with CMS and requires HCPCS modifiers GN, GO or GP to be reported with the codes designated by CMS as always therapy services.
Can you bill manual therapy and therapeutic activity together?
For example, Modifier 59 (distinct procedural service) can be used to indicate that manual therapy and therapeutic exercises were separate and necessary services provided during the same session, ensuring successful reimbursement while preventing denials.
Do I use modifier 95 or GT?
The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.