What is modifier GP 59?
Asked by: Rico Haag | Last update: October 9, 2025Score: 4.9/5 (17 votes)
When should a 59 modifier be used?
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.
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 physical therapy codes require a 59 modifier?
Therapists often use modifier 59 to bill for “two timed code procedures [that] are performed sequentially in the same encounter.” For instance, if you billed CPT codes 97140 (Manual Therapy) and 97530 (Therapeutic Activities)—and you provided those services during separate and distinct 15-minute intervals—then, as ...
How much does modifier 59 reduce payment?
A Modifier 59 attached to a procedure code indicates that it is a separate procedure and is NOT subject to the multiple surgical reduction; as a result, it should be paid at 100% of the fee schedule.
Modifer 51 and 59 in Medical Coding -- What's the Difference and which one should you use??
Under what circumstances would modifier 59 not be appropriate?
Modifier 59 should not be used (as it is unnecessary) if the narrative description of the two codes is different. Modifier 59 is used appropriately for two services described by timed codes provided during the same encounter only when they are performed sequentially.
When should modifier 59 be appended to a claim?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is an example of a modifier 59?
Another example would be if the patient were having a nerve conduction study with CPT codes 95900 and 95903 being billed. If the two procedures are done on separate nerves, then the 59 modifier should be used to indicate that. If the codes were performed on the same nerve, then the 59 modifier should not be used.
Does 97110 need a 59 modifier?
When billing 97110 and any of its pairs for the same session or date, modifier 59 is only appropriate if the two procedures are performed in distinctly different 15-minute intervals. Per 2021 NCCI edits, 97110 will need the 59 modifier if billed with any of the following CPT codes; 36591, 36592, 96523.
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.
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.
What is an example of a GP modifier?
GP Modifier Example:
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.
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 difference between modifier 25 and modifier 59?
Modifier -59, “Distinct Procedural Service,” is similar to modifier -25, but it's applicable to procedural, rather than E/M, services.
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).
Can modifier 59 be used with 99213?
If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.
Does a GP modifier have to be applied for all procedures for physical therapy?
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 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.
Can modifier 59 be used on labs?
Modifier 59 (distinct) and 91 (repeat) are valid modifiers for most laboratory services and should be used when multiple laboratory services described by a single code are provided to a patient on one day by the same provider.
What is the modifier 59 on a claim?
MODIFIER -59 IS USED TO IDENTIFY PROCEDURES/SERVICES THAT ARE NOT NORMALLY REPORTED TOGETHER, BUT ARE APPROPRIATE UNDER THE CIRCUMSTANCES.
Which modifier goes first?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first. There's a straightforward reason to this, too.
What is the CPT code for gastroenterology consultation?
The Current Procedural Terminology (CPT) code range for Gastroenterology Procedures 91200-91299 is a medical code set maintained by the American Medical Association.
How to use modifier 59 correctly?
Modifier 59 is used to identify procedures/services, other than Evaluation/Management services, that are not normally reported together, but are appropriate under the circumstances. XE, XS, XP, and XU are valid modifiers and provide greater reporting specificity.
What is the GP modifier?
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 97110 CPT code?
CPT® code 97110: Therapy procedure using exercise to develop strength, endurance, range of motion and flexibility, each 15 minutes.