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.
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Major Insurance Company Policy Changes
Both UnitedHealthcare/Optum and BCBSIL have made some policy changes that will impact many chiropractic physicians in Illinois and their patients.
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New UHC/Optum Modifier Requirements for Therapy
UHC/Optum will start their therapy modifier policy this Monday. The new policy requires the modifiers GN, GO, or GP on physical therapy codes.
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Medicare Requiring Modifier GP on Physical Therapy Services
On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released MLN Matters Number: MM10176. In this notice, CMS identified certain services subject to the therapy cap. The revision became effective on January 1, 2018. Due to this revision, some providers have begun to receive claim rejections because they are not using the appropriate modifier.
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