Does CPT 97110 require a modifier?
Asked by: Miss Zoe Heidenreich PhD | Last update: August 26, 2025Score: 4.4/5 (63 votes)
Does CPT code 97110 require a modifier?
Per 2021 NCCI edits, 97110 will need the 59 modifier if billed with any of the following CPT codes; 36591, 36592, 96523.
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.
When should a modifier 25 be used?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
What is the modifier for physical therapy?
GP Modifier Example:
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.
CPT Code 97110 vs CPT Code 97530 | Medicare Billing & Documentation
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.
When should modifier PT be used?
The –PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure.
Does 99213 need a modifier 25?
If the E/M is not bundled into the stress test, then the Cardiologist's coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
When should modifier 26 be used?
What you need to know. Modifier 26 is defined as the professional component (PC). The PC is outlined as a physician's service, which may include technician supervision, interpretation of results and a written report. Use modifier 26 when a physician interprets but does not perform the test.
Does CPT require a modifier?
According to CPT, the situations when the use of a modifier may be appropriate are: 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.
How do I know if a CPT code needs a laterality modifier?
The -RT and -LT modifiers should be used whenever a procedure is performed on one side. For instance, when reporting CPT code 27560 (closed treatment of patellar dislocation; without anesthesia), modifier -RT or -LT should be appended if only one knee is treated.
Does Medicare pay for physical status modifiers?
Medicare does not recognize or pay additional units for Physical Status, but many private payers do.
What is procedure code 97110?
CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.
Do all CPT codes require a modifier?
Modifiers provide additional information to payers to make sure your provider gets paid correctly for services rendered. If appropriate, more than one modifier may be used with a single procedure code; however, are not applicable for every category of the CPT codes.
Can a CPT 97110 be billed alone?
Regardless of whether code 97010 is billed alone or in conjunction with another therapy code, this code is never paid separately. If billed alone, this code will be denied.
How do you identify a modifier?
A modifier is a word, phrase, or clause that modifies—that is, gives information about—another word in the same sentence. For example, in the following sentence, the word "burger" is modified by the word "vegetarian": Example: I'm going to the Saturn Café for a vegetarian burger.
Where do I find CPT modifiers?
Please refer to Appendix A of the current CPT manual for a complete list of modifiers and their full CPT descriptions. CPT codes, modifiers, descriptions, and other data are copyrighted by the American Medical Association (AMA).
What is a 25 modifier used for in medical billing?
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.
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 required to bill a 99213?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
When to use modifiers?
- A service or procedure has both a professional and technical component, but only one component is applicable.
- A service or procedure was performed by more than one physician or in more than one location.
What modifier is used with 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)), ...
Does Medicare require modifiers for physical therapy?
Section 53107 of the BBA of 2018 additionally requires CMS, using a new modifier, to make payment at a reduced rate for physical therapy and occupational therapy services that are furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs).
What CPT codes are considered preventive?
Preventive visit codes 99381-99397 include “counseling/anticipatory guidance/risk factor reduction interventions,” according to CPT. However, when such counseling is provided as part of a separate problem-oriented encounter, it may be billed using preventive medicine codes 99401-99409.