Outpatient Rehabilitation Modifiers

January 9th, 2018 - Jared Staheli
Categories:   CPT® Coding   HCPCS Coding   Modifiers   Physical Medicine|Physical Therapy  
0 Votes - Sign in to vote or comment.

Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries.

For services delivered under an outpatient plan of care use modifier:

  • GN for speech-language pathology
  • GO for occupational therapy
  • GP for physical therapy

In addition to using the correct modifier, the provider must still be qualified to deliver the service. For example, adding modifier GP to a service performed by a non-qualified practitioner will not make the service payable.

These modifiers need to be used for any applicable physical therapy, occupational therapy, or speech-language pathology services. However, there are some codes that should not be billed with therapy modifiers, which include:

  • G0237 “Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)”
  • G0238 “Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)”
  • G0239 “Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)”
  • 95860 “Needle electromyography; 1 extremity with or without related paraspinal areas”
  • 95861 “Needle electromyography; 2 extremities with or without related paraspinal areas”
  • 95863 “Needle electromyography; 3 extremities with or without related paraspinal areas”
  • 95864 “Needle electromyography; 4 extremities with or without related paraspinal areas”
  • 95867 “Needle electromyography; cranial nerve supplied muscle(s), unilateral”
  • 95869 “Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12)”
  • 95870 “Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters”

See the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services, Section 20

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities
July 13th, 2022 - Dr. Evan M. Gwilliam, DC, MBA, QCC, CPC, CCPC, CPMA, CPCO, AAPC Fellow, Clinical Director
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
Medicare Advantage (MA) Benchmarking Policies Are Headed for Change
July 12th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
More than 43% of Medicare beneficiaries are not enrolled in Medicare Advantage plans, which were established to control costs and improve quality. However, as noted in the March MedPac Report Executive Summary of 2021, these plans average an estimated 104% of Medicare Fee-For-Service (FFS) spending. How does CMS plan to manage Medicare Advantage plans now?
How Extensions to the COVID-19 Public Health Emergency Affect Healthcare Reimbursement
June 28th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Providers need to begin preparations for how to handle a return to pre-COVID-19 public health emergency (PHE) policies. As the saying goes, "you can't put the rabbit back in the hat." Some COVID-19 PHE policies are so well liked it will be very difficult for the government to return to pre-COVID-19 policies. For now, we have at least the promise of a 60-day notice to all governors precipitating the end of the PHE.
Why You Should Be Using The Two-Midnight Rule
June 23rd, 2022 - David M. Glaser, Esq.
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...
Q/A: Service Period for 99490
June 6th, 2022 - Chris Woolstenhulme
Question: If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim? Answer: According to CMS, “The service period for CPT 99490 ...
Reporting CCM and TCM Codes with E/M Codes
June 1st, 2022 - Chris Woolstenhulme
When reporting CCM or TCM codes, you will only get reimbursed for what is allowed. The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...
Q/A: Billing Over the Allowed Amount
June 1st, 2022 - Chris Woolstenhulme
Question: Is there a financial penalty for billing over the allowed amount? Answer: Yes, if you are submitting claims to a contracted provider, you cannot bill over the contracted amount of your fee schedule. This is called balanced billing. There is also the no-surprise rule that protects insured and non-insured or ...



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association