Does CPT code 97140 need a GP modifier?
Asked by: Mr. Kevin Vandervort V | Last update: October 4, 2023Score: 4.8/5 (71 votes)
Importantly, when reporting 97140 to BCBSNC, NC State Health Plan (SHP), MedCost, the Focus Plan, or any plan which utilizes Zelis edits, and you are also billing a CMT code on the same date of service, you must append 97140 with modifier 59 and also modifier GP.
What modifier should be used with 97140?
Interestingly, many insurance companies will pay for the 97140 code as long as it is 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.
When should GP modifier be used?
The GP modifier indicates that a physical therapist's services have been provided. It's commonly used in inpatient and outpatient multidisciplinary settings. It's also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers.
What is CPT code 97140 billing guidelines?
CPT code 97140 for manual therapy defines techniques involving hands-on manipulation, lymphatic drainage, mobilization, and traction to one or more body areas. This is a timed code, requiring 15 minutes of direct patient care from a qualified professional for each unit.
Can chiropractors use the GP modifier?
GP is the most appropriate for chiropractic claims, as it aligns with the therapy provider “physical therapy”. This does not mean Medicare is paying chiropractic providers for therapy; however, GP is a necessary modifier to assure a proper denial for a secondary payer to make payment.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
Can a chiropractor bill 97140?
Chiropractic manual therapy involves the use of hands-on techniques to treat soft tissue and mobility restrictions in the extremities, neck and trunk. CPT code 97140 covers manual therapy techniques such as soft tissue and joint mobilization, manipulation, manual lymphatic drainage, and manual traction.
What insurance companies require the 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.
What is GP code 97140?
CPT® code 97140: Manual therapy techniques, 1 or more regions, each 15 minutes (Mobilization/manipulation, manual lymphatic drainage, manual traction)
Is CPT 97140 massage therapy?
CPT code 97124 is more so directed at massage therapy, while 97140 is actually for manual therapy. When using either of these massage therapy billing codes, be sure to cite these exact treatment procedures in your claim to ensure coverage.
Does 97140 need a modifier for Medicare?
Description of the manual therapy technique(s) location (e.g., spinal region(s), shoulder, thigh, etc.) Time (e.g., number of minutes spent performing the services associated with this procedure) meets the timed-therapy services requirement. CPT code 97140 is appended with the modifier -59 or the appropriate –X ...
What are GP modifiers?
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech-language pathology services. They should never be used with codes that are not on the list of applicable therapy services.
What is the difference between the GO modifier and the GP modifier?
GO – Service delivered personally by an occupational therapist or under an outpatient occupational therapy plan of care. GP – Service delivered personally by a physical therapist or under an outpatient physical therapy plan of care.
Does a GP modifier have to be applied for all procedures for physical therapy?
The Top Physical Therapy Modifiers PT's Should Know
GP Modifier is used for all “services provided under an outpatient physical therapy plan of care.” It is important that this physical therapy outpatient modifier code is utilized to ensure reimbursement.
Does the 59 modifier go on 97140 and 97530?
When using the 59 modifier, you are indicating to the insurance company that each service was medically necessary and performed independently of the other. One typical example of when to use this modifier is if you bill for manual therapy (97140) and therapeutic activities (97530), in the same session.
What is the modifier for manual therapy CPT code?
Modifier 59 Example
For example, let's look at one of the most commonly billed codes: 97140 (manual therapy techniques like mobilization/manipulation, manual lymphatic drainage, or manual traction on one or more regions, each for 15 minutes).
How to bill CPT 97110 and 97140?
In this instance, you would bill 2 units of 97110 and 1 unit of 97140. You count the first 30 minutes of 97110 as 2 full units. Then, compare the remaining time for 97110 (33-30=3 minutes) to the time spent on 97140 (7 minutes) and bill the larger, which is 97140. 18 minutes of therapeutic exercise, 97110.
How do you bill manual therapy?
Manual therapy can only be billed with CMT if the therapy was performed on a different body area, and modifier 59 would be appended to the manual therapy code (97140) to indicate this to the payer. CPT code 97140 is also a timed therapy code, and requires time documentation to support billing.
Can you bill 97140 for dry needling?
Absent a specific payer policy, the use of CPT code 97140 for the performance of dry needling should not be utilized.
What modifier do I use for massage therapy?
According to the National Correct Coding Initiative (NCCI), massage therapy (97124) and manual therapy (97140) are considered to be linked, meaning if one of these codes is billed, only one payment may be received despite two services being provided. 4 In this instance, the modifier “-59” is often recommended.
How much is CPT code 97140 reimbursement?
For example, payment for therapeutic exercise (CPT code 97110) will drop by an average of 3.3%, from $31.40 in 2020 to $30.36 this year, with manual therapy (97140) seeing a similar percentage decrease, from $28.87 in 2020 to $27.91 in 2021.
Can 97140 be billed with 97110?
33 minutes of therapeutic exercise, code 97110 7 minutes of manual therapy, code 97140 Total timed code treatment time is 40 minutes. If you look up 40 minutes on the chart, you can bill for a maximum of 3 units (38 to 52 minutes). You can bill 2 units of 97110 and 1 unit of 97140.
What does GP code mean?
GENERAL MEDICAL PRACTICE CODE (PATIENT REGISTRATION) is the ORGANISATION CODE of the GP Practice that the PATIENT is registered with.
Do I use modifier 95 or GT?
A GT modifier is an older coding modifier that serves a similar purpose as the 95 modifier. CMS recommends 95, different companies have varying standards for which codes to be billed. It is a good idea to check with the plans before billing.
Does a CPT code for 97110 need a 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.
Does modifier GP affect reimbursement?
GC modifier has no impact on payment unless it is discovered on appeal that the teaching physician failed to document and electronically sign their attestation note.