Does a GP modifier have to be applied for all procedures for physical therapy?
Asked by: Harvey Mertz | Last update: February 22, 2025Score: 4.5/5 (9 votes)
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.
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.
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.
What is the rule of 8 for Medicare physical therapy?
Per Medicare rules, to bill one unit of a timed CPT code, you must perform the associated modality for at least 8 minutes. Medicare adds up the total minutes of skilled, one-on-one therapy and divides the sum by 15. If eight or more minutes are left over, you can bill for an additional unit.
Physical Therapy 59 Modifier Update 2020
What is the rule of 8 in physical therapy?
The key feature of the 8-minute rule—and the origin of its namesake—is that a therapist must provide direct treatment for at least eight minutes to receive payment from Medicare for a time-based (or constant attendance) CPT code.
How many PT sessions allowed by Medicare?
How many visits of physical therapy am I allowed per year? There is not a set number of visits that you are allowed by Medicare per year. Instead, it's determined by medical necessity.
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.
What modifier is used for multiple procedures?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
Can chiropractors use the GP modifier?
UHC Claims Will Require GP Modifier For Therapy Codes
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.
What modifier do you use for physical therapy?
The GP modifier is used in any case where the rendering provider is a physical therapists. If physical therapist provides a therapeutic exercise (CPT code 97110) in an outpatient setting, they would bill for this service as "97110-GP" to denote the provider of the service.
Is 97110 a physical therapy code?
CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.
When would you use the PT modifier?
The –PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure.
Does 97110 need a modifier?
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.
How do you know when to use 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.
What are CPT codes for physical therapy?
- What are CPT codes? ...
- Commonly Used CPT Codes in Physical Therapy. ...
- 97110: Therapeutic exercise. ...
- 97112: Neuromuscular Re-education. ...
- 97116: Gait training. ...
- 97124: Massage Therapy. ...
- 97140: Manual therapy. ...
- 97150: Group Therapy.
What is the multiple procedure rule?
Multiple Procedure Payment Reduction currently applies to multiple diagnostic imaging services administered to the same patient during the same day and entails a 50% decrease in the technical component and a 25% decrease in the professional component reimbursement.
When to use 59 modifier in physical therapy?
Modifier 59 isn't your billing-free card.
You should apply modifier 59 to denote when you have provided a typically bundled service wholly separate from its counterpart. That's it.
What is the modifier 25 rule?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
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 CPT code 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.
Do telehealth visits need a modifier?
Instead, telemedicine visits should be reported using in-person E/M codes (e.g., 99202–99215) with: Modifier 95 for audio-video visits. Place of service codes 02 (non-home location) or 10 (telehealth in home)
Why does Medicare deny physical therapy?
Medicare will not pay for physical therapy services unless the claim and documentation prove that a licensed physician has authorized the plan of care.
Does Medicare pay 100% of physical therapy?
Medicare Part B covers physical therapy in a doctor's or therapist's office, or at home if you are unable to travel. Part B will pay 80% of the Medicare-approved amount after you pay your Part B deductible ($240 in 2024).
How many patients can a PT see in a day?
Question #4: What is the average number of patients your PT's see in an 8 hour day? works out to 12-14 per day. One per hour.