What is the modifier for physical therapy insurance?
Asked by: Mr. Wilson Blanda | Last update: November 5, 2025Score: 4.8/5 (4 votes)
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 97 for physical therapy?
Rehabilitative (modifier 97) services that help a person RESTORE functions which have become either impaired or lost.
What is the 96 modifier for physical therapy?
Physical Therapy Billing Modifier 96 & Modifier 97
Habilitative treatment would include all treatments that help patients develop a skill, movement, or function that they were not able to learn on their own.
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.
Medical Coding GA and GX Modifiers for PT
What is the 59 modifier used for?
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 the 25 modifier used for?
The Current Procedural Terminology (CPT) definition of Modifier 25 is as follows: Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.
What modifier to 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.
What is the PT modifier code?
The –PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure. 3) Use an appropriate ICD-10 diagnosis code to indicate the procedure was a screening procedure.
What is a 24 modifier?
Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.
Does Medicare accept PT modifier?
Modifier PT is a level II modifier that indicates that a colorectal screening service was converted to a diagnostic or therapeutic service. Medicare covers screening colonoscopies without a co-pay or deductible and coinsurance.
When to use modifier 99?
99 Used when two or more modifiers are necessary to completely delineate a service; the multiple modifiers used must be explained in the Remarks field (Box 80)/Additional Claim Information field (Box 19) of the claim or on an attachment.
When should modifier 57 be used?
Modifier -57 is appended to office visits the same day or within three days of a major surgery (90-day global period). It indicates the office visit includes the decision for the major 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.
What is the 97 modifier for physical therapy?
The -96 modifier is used when the physical therapy services are habilitative in nature. The -97 modifier is used when the physical therapy services are rehabilitative in nature. The CO, CQ, GO, GP modifiers are all modifiers that indicate who performed the service.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
What is modifier 51 used for?
CPT guidelines explain the 51 modifier should apply when “multiple procedures, other than E/M services, are performed at the same session by the same individual. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).”
What physical therapy codes require 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 ...
What does the 59 modifier mean?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.
What is an example of a xe modifier in physical therapy?
XE (Separate Encounter)
Modifier XE indicates a service was distinct because it occurred during a separate encounter. Example: A PT bills a single unit of group activity (97150) for three patients, then follows up with each patient one on one and bills two units of 97112.
When to use modifier 24?
- This modifier may be used to indicate that an evaluation and management (E/M) service or eye exam, which falls within the global period of a major or minor surgery and which is performed by the surgeon, is unrelated to the surgery. ...
- This modifier may only be submitted with E/M and eye exam codes.
When to use modifier 26?
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.
What modifier is 50?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).