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97001 physical therapy evaluation

Yevgeny Posted Wed 11th of June, 2014 17:09:14 PM

we've been billing 97001 with GP modifier, in 2014 this procedure/modifier has been denied for all the patients. whats is the new code?

SuperCoder Answered Thu 12th of June, 2014 08:04:03 AM

Thank you for your question.

Are you billing any other codes with the 97001? In my research I have found the modifier GP is with 97001 is appropriate. Are all payers denying? What is the denial reason? Any specific information you can provide may help.

Medicare posted the guidelines below in 2013:
Effective for therapy claims with dates of se
rvice on or after January 1, 2013 and processed on
and after April 1, 2013, through June 30, 2013, contractors will alert providers, who submit claims
containing any of the following
CPT evaluation/re-evaluation
therapy codes 92506, 92597, 92607,
92608, 92610, 92611, 92612, 92614, 92616, 96105,
96125, 97001, 97002, 97003, 97004 without
functional information, that these codes
require functional G-code(s) and appropriate
severity/complexity modifier (s), and effective July 1, 2013, claims that do not include required
functional reporting information will be returned
or rejected. The following CARC and RARC will
be used as the alert message
:

CARC 246
- “This non-payable code is for required reporting only.” and

RARC N566
- “Alert: This procedure code requires functional reporting. Future claims
containing this procedure code must incl
ude an applicable non-payable code and appropriate
modifiers for the claim to be processed.””
when CPT codes 92506, 92597, 92607, 92608,
92610, 92611, 92612, 92614, 92616, 96105, 97001,
97002, 97003, or 97004 are submitted
without the nonpayable HCPCS codes G8978
to G8999, G9158 to G9176, or G9186 and
the appropriate modifier (CH – CN).

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