Are Missing Modifiers Causing Therapy Code Denials?
United Healthcare and others now require the GP modifier on certain therapy codes. Chiropractic physicians should check requirements to avoid denials and ensure proper reimbursement.
Today’s links and information:
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List of therapy codes that some insurers MAY require a GP modifier (Medicare always does):
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, 97763, 97799, G0281, G0283
Transcript:
We’re getting an increasing number of calls from doctors who are running into challenges with certain therapy codes getting denied by a number of different carriers, and the denial reason comes back that it’s missing a modifier, and what we’re finding is many carriers, in fact, we can name United Healthcare is one of them, has adopted, and this has been going on for quite a while, but they’ve adopted Medicare edits specific to therapy codes that are being billed. What you may not know is back, shoot now, about seven years ago, Medicare implemented some changes with what they call always therapy codes and they require that specific modifiers are attached to delineate and to specifically indicate that these are therapy codes that fit under a specific regimen of limited services available under the Medicare system.
So what that basically means is, on these specific therapy codes, you have to append a modifier, and the modifier includes GP, GO, or GN modifiers. Now, a GO modifier is for occupational therapy, a GN is for speech therapy. Let’s discard those, they aren’t going to be used very often, but GP modifier and that is as in-game G and P, as in, purpose, or whatever word you want to throw in there. But GP modifiers are required for some insurance carriers. They’re always required for Medicare, but they’ve now become required for United Healthcare and a few other insurers. So, when you get those return claims, it indicates on some of your therapy codes that it’s being denied because you’re missing a modifier. Many times your minds go to the 59 modifier, but in truth, it may just simply be the GP modifier. And so if you’re billing some of those and you haven’t run into a 59 modifier issue in the past, you may want to consider looking at the GP modifier or look back at your communications that you would receive from that insurer to see if they’re now requiring the GP modifier. What codes is this going to apply to, or what codes does it apply to? It would be codes like 97012, 97032, 97039, 97110, 97112, 124, 7140, and G0283.
On those particular codes, you may be required to append the GP modifier. Now, if you’re billing Medicare, you want to make sure you append the GP modifier, even though we know that those services aren’t covered for chiropractic physicians, because you want to make sure that the secondary insurance, if that exists, properly, processes the claim. You also want to make sure that Medicare properly process the denial so you can collect from the patient appropriately. We hope this information helps you out, and I’ll also include a full list of the codes that you’ll want to look for, that you may be utilizing in your practice. We’ll add that down below in this video. Hopefully, this information helps you out. We’ll catch you next week.
