Billing best practices for Physical Therapists

Billing best practices for physical therapists_newUse Modifiers to identify therapy services whether or not financial limitations are in effect. The national Common Working File (CWF) database tracks the financial limitation based on the presence of therapy modifiers. Providers/suppliers must continue to report one of these modifiers for any therapy code on the list of applicable therapy codes. These modifiers do not allow a provider to deliver services that they are not qualified and recognized by Medicare to perform.

Outpatient Therapy Code Modifiers must be used when billing Medicare for outpatient therapy.

GN (Services delivered under an outpatient speech-language pathology plan of care),

GO (Services delivered under an outpatient occupational therapy plan of care),

GP (Services delivered under an outpatient physical therapy plan of care)

This modifier is entered in Box 24D in the HCFA 1500 and just past  SVC*HC in the 5010-837.  Without this modifier you will not be paid.

At present a lot of clinics bill 2 different codes to payers, one that includes the modifier and a set of codes that do not. In talking to several billers they keep a list of payers that need the modifier and those that do not. In testing several payers I have noticed that the payers that do not require the modifier, do not care if the modifier is present.

My suggestion for Best Practice to both save time and coding is to bill using the modifier on all CPT codes, this way it will save you time and expense in trying to figure one coding vs. another coding for a particular payer.

You may find a particular payer in your region that will not process the claim, but for the most part APOLLO has notice payers paying on the CPT regardless of modifiers.