When to add GP modifier?
Asked by: Katelynn Wiegand | Last update: July 6, 2025Score: 4.2/5 (28 votes)
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 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.
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.
Does 97110 need a GP modifier?
If a physical therapist provides, say, therapeutic exercise, they might use the CPT code 97110. As therapeutic exercise would likely fall within the patient's physical therapy plan of care, the modifier would be added to the code, so it reads “97110-GP.” It's that simple.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
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.
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.
Can a chiropractor use GP modifier?
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.
What is the difference between 97110 and 97530?
For example, use 97110 for conditions like muscle weakness or joint stiffness. For 97530, link to broader functional limitations such as difficulty lifting or maintaining balance.
When to use at modifier?
HCPCS Modifier AT — acute treatment (chiropractic). This modifier is submitted with chiropractic treatment codes when the chiropractor furnishes acute treatment. This modifier may only be submitted with CPT codes 98940, 98941 and 98942.
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 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 telehealth visits need a modifier?
While this might seem complex, in most cases, billing for telemedicine will look largely similar to billing for in-person healthcare services. The main difference is the need to add a modifier.
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.
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).
Which modifier should be listed 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.
What is CPT code 97110 with GP modifier?
Modifiers GP(Outpatient Physical Therapy), GO (Outpatient Occupational Therapy), GN (Outpatient Speech-Language Pathology), CO (Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)), CQ (Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)), ...
Does CPT 97530 require a modifier?
The therapist can bill for CPT code 97530 with modifier 59 added on, as long as the services were performed during separate 15-minute increments. GP/GO/GN Modifier: In an interdisciplinary setting, this modifier may be used to clarify who provided the services.
What is the difference between therapeutic exercise and gym activity?
General exercise is essentially a “work out”. It is exercise for wellness, overall health, appearance, fun, leisure etc. Therapeutic exercise is specifically for individuals who have a physical problem / impairment, which is often painful.
When to use GP modifier?
The GP modifier is a two-character code appended to Current Procedural Terminology (CPT) codes to indicate that the services provided are related to physical therapy. It signifies that the service was delivered by a licensed physical therapist or physical therapist assistant.
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.
Can a chiropractor bill 99214?
E/M codes 99214, 99215, 99204 or 99205 will not be allowed with manipulative treatment codes.
Does CPT 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.
What does mue stand for in medical coding?
National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), to reduce improper payments for Part B claims.
Can you bill 3 units of 97110?
20 minutes therapeutic exercise, 97110. 40 minutes total treatment time. The 40 total treatment time falls within the range for 3 units (see chart). Each service was performed for at least 15 minutes and should be billed for at least 1 unit, but the total allows 3 units.