Policy Statement
The Plan will reject claims for physical, occupational, and speech therapy services if modifiers are not appended appropriately.
Physical Therapy
The Current Procedural Terminology (CPT) physical medicine and rehabilitation codes, as well as other services that require supervised/constant attendance modalities, wound therapy, testing, assessments, evaluations, and re-evaluation services may be submitted by a physical therapist.
Coding Rules
- Professional Claims: Each line of service submitted by a Physical Therapist must include modifier GP.
- Outpatient Facility Claims: Each line of service submitted with revenue code 042X must include a GP Modifier.
Occupational Therapy
The CPT physical medicine and rehabilitation codes, as well as other services such as splints, strapping, testing, assessments, evaluations and re-evaluation services may be submitted by an occupational therapist.
Coding Rules
- Professional Claims: Each line of service submitted by an Occupational Therapist must include modifier GO.
- Outpatient Facility Claims: Each line of service submitted with revenue code 043X must include a GO Modifier.
Speech Therapy
Speech-Language Pathologist should use appropriate CPT codes for their speech therapy services and for evaluation and treatment of swallowing dysfunction.
If a speech evaluation is done over a period of two days and only one report is generated upon completion of the evaluation, submit the evaluation code only once with the date of service the evaluation was completed.
Coding Rules:
- Professional Claims: Each line of service submitted by a Speech-Language Pathologist must include modifier GN.
- Outpatient Facility Claims: Each line of service submitted with revenue code 044X must include a GN Modifier.
References
None
Cross References
- Adm 129 – Correct Coding Guidelines
- Provider Manual
