What insurances require a GP modifier?
Asked by: Ara Ryan PhD | Last update: October 13, 2025Score: 5/5 (36 votes)
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.
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 UnitedHealthcare require a 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.
Who can bill with a GP modifier?
Used in conjunction with CPT® (Current Procedural Terminology) codes, the modifier “GP” shows that the therapy services were specifically provided by a physical therapist. This helps ensure accurate billing and reimbursement for physical therapy services under Medicare and other insurance company plans.
Advance Beneficiary Notice of Noncoverage (ABN) Modifiers and Tips
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 not accepted by Medicare?
GZ - Service is not covered by Medicare
The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member.
Do chiropractors use GP modifiers?
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 Medicare require a modifier for telehealth?
Virtual check-ins and e-visits must technically be initiated by a patient; however, physicians and other providers may need to educate beneficiaries on the availability of the service prior to patient initiation. There are no POS or modifier requirements for virtual check-ins or e-visits.
What payers require GC modifier?
Government payers (Medi-Cal and Medicare) require the GC modifier to be appended to E/M codes when a resident, under the direction of a teaching physician in an approved teaching program, is involved in the care of a patient.
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.
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.
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 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.
What is the 59 modifier for BCBS?
Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
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.
Does Medicare require GP modifier?
On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released MLN Matters Number: MM10176. In this notice, CMS identified certain services subject to the therapy cap. The revision became effective on January 1, 2018.
Do you use 95 or GT modifier for telehealth 2024?
For institutional billing, use modifier 95 for dates of service on and after January 1, 2024, through December 31, 2024, when: The clinician is in the hospital and the patient is in their home. Outpatient therapy provided via telehealth by PTs, OTs or SLPs employed by hospitals.
What modifier does Aetna use for telemedicine?
Modifiers GT, 95, FR
When a provider reports modifier GT or 95, it certifies the patient received services via an audiovisual telecommunications system. Click herefor more information about our telemedicine liberalization in response to the Coronavirus COVID-19 outbreak.
Will a GP refer you to a chiropractor?
Most chiropractors work in the private sector either alone, or in group practices. In some areas, chiropractic may be available on the NHS and a GP may be able to refer you, but this is rare.
What is the most common modifier we use in dermatology?
The “XS” modifier is most pertinent to dermatologists and is used to represent two procedures performed in the same encounter. But on different organs or structures. For dermatologists, this would mainly be used to indicate different anatomic locations on the skin.
What modifier do I use for massage therapy?
Guidelines for Using Modifier 59:
Apply Modifier 59 to CPT 97124 when the therapeutic massage is performed on a different body area than other treatments. Ensure each service is clearly documented, specifying the distinct anatomical locations and treatment objectives.
What are three services not covered by Medicare?
We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.
What are the most used modifiers in medical billing?
Understanding commonly used modifiers in medical billing is crucial for accurate reimbursement and avoiding claim denials. Modifiers such as 22, 25, 26, 33, 50, 51, and 59 play a significant role in communicating additional information about the services provided.
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.