When should GP modifier be used?

Asked by: Dr. Jettie Konopelski  |  Last update: May 3, 2025
Score: 4.5/5 (3 votes)

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.

When to use 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 insurances require a 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.

Does 97110 need a GP modifier?

Answer: The GP modifier is used to indicate that the services provided are part of an outpatient physical therapy plan of care. 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.

When should the GC modifier be used?

Modifiers GC and GE are used to identify the involvement of a resident in the care of the patient. These modifiers should be used on Medicare and Medicaid patients whenever a resident is involved in the care provided.

What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners

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What payers require the 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.

How do you know if a code needs a modifier?

What Are Medical Coding Modifiers?
  • 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.

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.

Do chiropractors use 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.

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 UnitedHealthcare require 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.

Do telehealth visits need a modifier?

Instead, telemedicine visits should be reported using in-person E/M codes (e.g., 99202–99215) with: Modifier 95 for audio-video visits. Place of service codes 02 (non-home location) or 10 (telehealth in home)

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.

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 modifier be used?

“Its use allows two E/M services or a procedure plus an E/M service that are distinctly different but required for the patient's condition to be appropriately reported and, therefore, appropriately paid,” the issue brief says. The use of modifiers provides supplementary information for payer policy requirements.

How do you know if a modifier is used correctly?

A modifier is a word, phrase, or clause that provides description.
  1. Always place modifiers as close as possible to the words they modify. ...
  2. A modifier at the beginning of the sentence must modify the subject of the sentence. ...
  3. Your modifier must modify a word or phrase that is included in your sentence.

Who can use modifier GP?

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.

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 is the billing rule for 99214?

Here are the key guidelines for accurate usage of billing code 99214:
  • Medical Necessity. ...
  • Present Illness Documentation. ...
  • Chief Complaint. ...
  • Review Symptoms. ...
  • Detailed Physical Exam. ...
  • Past, Family and Social History. ...
  • In-depth History. ...
  • Medical Decision Making.

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.

Can you bill an office visit with a cast application?

A charge for procedure codes 29000-29590 is allowed only when the casting or strapping is a replacement procedure used during the period of follow-up care. The charge for an office visit is allowed only if significant identifiable further services are provided at the time of the cast application or strapping.

What modifier is not commonly used in E&M coding?

Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”

What are modifier rules?

Modifier Basics

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.

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.