Accurate billing and coding are essential yet complex tasks for medical professionals. Selecting the right modifier according to the code and provided services makes billing more challenging. These challenges can only be tackled with proper guidelines.
In this blog, we will provide guidance on the correct application of the GP modifier for physical therapy. We will discuss what the GP modifier signifies, its practical application in various scenarios, and the billing best practices. So, are you ready to bill your physical therapy services with an accurate modifier?
GP Modifier – Description
If we explain this modifier in one line, it denotes “services delivered under an outpatient physical therapy plan of care.”
Still not clear about the description? Let us explain! GP is a commonly used physical therapy modifier. It indicates that the physical therapy services were provided by a licensed therapist or an assistant as part of a well-established treatment plan. Moreover, the services were rendered in an outpatient setting. Therefore, rehabilitative activities for a patient staying at a skilled nursing facility or hospice cannot be tagged with this modifier.
You may report GP modifier in various outpatient settings, such as:
- Community Health Centers (CHCs)
- Comprehensive Outpatient Rehab Facilities (CORFs)
- Federally Qualified Health Centers (FQHCs)
- Home Health Agencies
- Hospital Outpatient Departments (HOPD)
- Physician Offices
- Private Practices
GP Modifier – Usage Examples
Let’s look at a couple of practical examples to explore the applications of a GP modifier in various outpatient settings.
Post-Stroke Therapy in HOPD
Suppose a patient had a stroke that impacted his right leg, causing limited knee movements. He visits his nearest hospital for essential physical therapy services post-stroke. During therapy, the certified physical therapist evaluates the patient’s condition and helps him perform therapeutic exercises for knee movement. The therapeutic exercises focus on strengthening his knee.
In this case, physical therapy services may be billed with CPT code 97110, and a GP modifier may be appended to indicate the services were rendered under a physical therapy care plan in an outpatient hospital department.
Physical Therapy for Low Back Pain
Let’s consider another scenario where a patient visits a private practice for treatment of chronic low back pain. His treatment includes basic physical therapy. A certified physical therapist performs manual therapy, applying various joint mobilization techniques and soft tissue massage to reduce pain and increase functional mobility.
Since the services include manual therapy in an outpatient setting of a private practice, the CPT code 97140 must be billed with a GP modifier.
Accurate Usage Guidelines for GP Modifier
The following are some essential guidelines you must follow to avoid receiving denials for claims billed with this modifier.
Understand the Description
The description of modifier GP clearly states that only a qualified physical therapist should bill it. Therefore, an occupational therapist or a speech-language pathologist cannot apply the GP modifier for physical therapy. Furthermore, the PT services should have been furnished in an outpatient setting and as part of an established plan of care. In simple words, you must keep in mind the basic description of this modifier while billing it.
Prepare Your Documents
Every insurance payer expects evidence and proof of the medical necessity of the service you are trying to bill. Hence, it is essential to maintain accurate and detailed documentation of the rendered PT services to justify the GP modifier’s usage.
Your supporting documentation should include details of the physical therapy plan of care, the services provided, activities performed, the date and duration of each service, and the progress and response to treatment.
Comply with the Rules of Insurance Payers
Complying with the guidelines set by various insurance payers is essential while appending a GP modifier. Medicare essentially requires a modifier GP with physical therapy services to differentiate PT from other occupational therapy (GO) and speech therapy (GN). However, some private insurance payers do not require a GP modifier for physical therapy services.
Hence, you must stay updated with payers’ policies to maintain compliance, avoid billing mistakes, and secure payments without delays or denials. Also, be sure to follow the Medicare 8-minute rule for PT unit-based billing.
Final Thoughts
Before we wrap up this blog, here is a quick recap of everything we have learned about the GP modifier.
We began this guide with a description of the modifier, which explains that the service was part of an outpatient physical therapy plan of care. The modifier can be used for services rendered in various outpatient settings, such as the outpatient department of a hospital or a private practice. You must attach detailed documentation and follow Medicare’s 8-minute rule to support the application of modifier GP.
With all that said, theremay still be a chance that this guide failed to address the exact problem you are currently facing. In this case, you may hire professional physical therapy billing services.
FAQs
Do chiropractors use the GP modifier?
Yes, chiropractors are required to use this modifier because they are considered physical therapy providers. However, the therapy must be provided under an outpatient physical therapy plan of care as part of “Always Therapy” code requirements.
Does Medicare allow modifier GP?
Medicare not only allows but also requires a GP modifier with physical therapy codes. If you do not apply the GP modifier for physical therapy services when billing Medicare, your claim may get denied.
Is the GP modifier only for Medicare?
No, this modifier is not limited to Medicare. Some other insurance payers, such as Blue Cross Blue Shield (BCBS) and Medicaid, also require modifier GP if the claim is for physical therapy services. However, you must check the insurance payer’s policy manual before submitting claims with this modifier.
Does CPT code 97140 need a GP modifier?
Yes, this modifier can be appended to CPT code 97140 (manual therapy). However, these manual therapy services must have been performed in an outpatient setting and as part of a physical therapy care plan.
