Billing with a GP Modifier

by  Wyn Staheli, Director of Research
January 15th, 2018

Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
 
A: Medicare recently released an article stating that in order to track physical therapy caps, one of three therapy modifiers (i.e., GN, GO, or GP) needs to be added to the code on the claim. There are some MACs which have required modifier GP in this situation. All of the following codes are on that list:
97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761, 97762 (this code was deleted and replaced by 97763 for 2018), 97799, G0281, G0283
Your MAC likely updated their claim editing to to reflect this update and are now requiring this modifier since of the three modifiers, GP is the most appropriate in a chiropractic setting. Click here to review the Medicare article.
 
See also: Medicare Requiring Modifier GP on Physical Therapy Services

Billing with a GP Modifier. (2018, January 15). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/billing-with-a-gp-modifier-34649.html

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)


Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


contact

innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email:
free demo
request yours today
pricing
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.