Who can use a GP modifier?
Asked by: Dr. Oren Connelly DVM | Last update: December 22, 2025Score: 4.3/5 (67 votes)
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 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 the difference between GP and go modifier?
Specialty Specific Modifiers
Modifier GO – Services delivered under an outpatient occupational therapy plan of care. Modifier GP – Services delivered under an outpatient physical therapy plan of care.
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 is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
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.
Do you use 95 or GT modifier for telehealth 2024?
For institutional billing, use modifier 95 for dates of service on and after January 1, 2024, through December 31, 2024, when: The clinician is in the hospital and the patient is in their home. Outpatient therapy provided via telehealth by PTs, OTs or SLPs employed by hospitals.
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 modifier for a wellness visit?
Coding and Billing a Medicare AWV
It is important that the elements of the AWV not be replicated in the medically necessary service. Physicians must append modifier -25 (significant, separately identifiable service) to the medically necessary E/M service, e.g. 99213-25, to be paid for both services.
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.
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.
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.
Does GP modifier affect reimbursement?
Effect on Reimbursement:
The presence or absence of the GP modifier directly influences reimbursement for physical therapy services. When properly appended to CPT codes, the GP modifier signals to insurance payers that the services were provided by qualified physical therapy professionals.
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)), ...
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.
Can an RN bill for an annual wellness visit?
Can a registered nurse perform the AWV? Yes, for billing purposes. However, registered nurses are not on the list of acceptable physician specialties for RA purposes.
Is there a modifier for telehealth visits?
What are the different telehealth modifiers? There are several modifiers that may be appended to telehealth services. The modifier may depend on the type of service. -95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
Who can perform an annual wellness visit?
Medicare Part B covers the Annual Wellness Visit (AWV) if it is furnished by a: • Physician (doctor of medicine or osteopathic medicine) • Physician assistant • Nurse practitioner • Clinical nurse specialist • Medical professional (including a health educator, a registered dietitian, nutrition professional, or other ...
Why is GP modifier used?
The GP modifier indicates that a physical therapist's services have been provided. It's commonly used in inpatient and outpatient multidisciplinary settings. It's also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers.
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.
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.
When to use GT modifier?
The GT modifier is used to indicate the session was administered via a telecommunications system. The reason the GT modifier is used is to signify to the insurance company the delivery of your services has changed (i.e. over video call).
Can you bill a telehealth and office visit on the same day?
E-visits should not be billed on the same day the physician reports an office visit E/M service (CPT codes 99202-99205 and 99211-99215) for the same patient. Additionally, e-visits should not be billed when using the following codes for the same communication: 99091.
What is the reimbursement rate for 99214?
Medicare Reimbursement Rates for CPT Code 99214
As an established patient evaluation and management code, CPT code 99214 is reimbursed at a rate of $141.78 by Medicare. This reimbursement rate applies to services provided in an office or outpatient setting.