When should the GE modifier be used?
Asked by: Dr. Arnaldo Tremblay IV | Last update: October 19, 2025Score: 4.9/5 (55 votes)
When to use the GE modifier?
Modifier GE
This service has been performed by a resident without the presence of a teaching physician under the primary care exception. Note: The patient medical record must document the extent of the teaching physician's participation in the review and direction of the services furnished to each beneficiary.
When should the QW modifier be used?
Modifier QW is used to indicate that the diagnostic lab service is a Clinical Laboratory Improvement Amendment (CLIA) waived test and that the provider holds at least a Certificate of Waiver.
When should 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.
How do you know when to use 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.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
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.
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.
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 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.
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.
When should a gy modifier be used?
The GY modifier should only be used for an item or service that is statutorily excluded or does not meet the definition of any Medicare benefit. The GY modifier is only to be used when the service is never covered by Medicare.
What tests are CLIA waived?
By the CLIA law, waived tests are those tests that are determined by CDC or FDA to be so simple that there is little risk of error. Some testing methods for glucose and cholesterol are waived along with pregnancy tests, fecal occult blood tests, some urine tests, etc.
What is the QF modifier used for?
QF: Used if the documented flow requirement on an “at rest” qualifying test is >4 LPM, and portable oxygen is prescribed.
When should modifier QW be used?
Medicare uses modifier QW to indicate that a test is CLIA-waived and the reporting physician's practice has a CLIA certificate that allows the physician to perform and report CLIA-waived tests.
When should modifier GT be used?
The GT modifier is typically used when a service would normally be provided in person but instead takes place remotely.
Which modifier should go first?
Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) should be listed after the payment modifier. If multiple informational/statistical modifiers apply, you may list them in any order (as long as they are listed after payment modifiers).
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.
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.
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.
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 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.
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 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).
What is the golden rule of modifiers?
It is crucial to position modifiers as near to the words they modify as feasible to guarantee clarity and accuracy. Place adjective and adverb modifiers before or after the words they modify. To minimize confusion, phrases and clauses should be placed close to the words they change.
What are the 5 types of modifiers?
As illustrated below, modifiers in English include adjectives, adverbs, demonstratives, possessive determiners, prepositional phrases, degree modifiers, and intensifiers. Modifiers that appear before the head are called premodifiers, while modifiers that appear after the head are called postmodifiers.