by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
April 20th, 2017
The Local Coverage Determination (LCD) for Outpatient Physical and Occupational Therapy Services describes the coverage limits of outpatient physical and occupational therapy services under Medicare Part B. It's billed to either the Medicare Fiscal Intermediary (FI) or Part A or Medicare Carrier or Part B MAC when services are provided under a therapy plan of care. The claim must include one of the following modifiers to distinguish the discipline of the plan of care under which the service is delivered:
GO - Services delivered under an outpatient occupational therapy plan of care; or,
GP - Services delivered under an outpatient physical therapy plan of care.
The modifiers are applicable to all claims from physicians, nonphysician practitioners (NPPs), physical therapists in private practice (PTPPs), occupational therapists in private practice (OTPPs), comprehensive outpatient rehabilitation facilities (CORFs), outpatient rehabilitation facilities (ORFs), outpatient hospital departments, skilled nursing facilities billing under Medicare Part B, home health agencies (when not rendered under a home health plan of care, but rendered under a therapy plan of care), and any other billing for physical or occupational therapy services.