Billing Physical (PT), Occupational (OT), and Speech Therapy (ST) Claims with Modifiers
3/26/2019
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Posted by Provider Relations
As a reminder, the Centers for Medicare and Medicaid Services (CMS) guidelines indicate that claims billed for physical, occupational, and speech therapy services must be submitted with the appropriate modifier.
Please ensure that your PT, OT, and ST therapy claims are submitted with the appropriate modifier to prevent payment disruption. The therapy modifiers are as follows:
Therapy Modifiers:
GN= speech therapy
GO = occupational therapy
GP = physical therapy
Professional Claims (CMS-1500) billed with any of the “always therapy” codes, must be billed with the appropriate therapy modifier (GN, GO, GP) appended to the claim.
Institutional Claims (UB-04) billed with revenue codes 42x, 43x, and 44x, must be billed with the appropriate therapy modifier (GN, GO, GP) appended to the claim as follows:
• Revenue code 42x (physical therapy) lines may only contain modifier GP
• Revenue code 43x (occupational therapy) lines may only contain modifier GO
• Revenue code 44x (speech-language pathology) lines may only contain modifier GN.
For further information, visit: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10176.pdf
Please be advised that PT, OT, and ST therapy claims not billed with the appropriate modifier will be denied.