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GP MODIFIER FOLLOW UP

SuperCoder Posted Thu 13th of October, 2011 14:07:28 PM

HOW DO YOU SUBMIT A CLAIM FOR PHYSICAL THERAPY SERVICES RENDERED BY PHYSICIAN / DIRECTLY SUPERVISED BY PHYSICIAN / OR INCIDENT TO A PHYSICIAN. DOES THE CPT FOR THERAPEUTIC EXERCISE '97110' GET BILLED WITHOUT THE GP???

SuperCoder Answered Thu 13th of October, 2011 18:45:06 PM

The CMS identifies certain codes listed at:
https://www.cms.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage
as “sometimes therapy” services, regardless of the presence of a financial limitation. Claims from physicians (all specialty codes) and nonphysician practitioners, including specialty codes “50” (Nurse Practitioner), “89,” (Clinical Nurse Specialist), and “97,” (Physician Assistant) may be processed without therapy modifiers when they are not therapy services. On review of these claims, “sometimes therapy” services that are not accompanied by a therapy modifier must be documented, reasonable and necessary, and payable as physician or nonphysician practitioner services, and not services that the contractor interprets as therapy services.
The CWF will capture the amount and apply it to the limitation whenever a service is billed using the GN, GO, or GP modifier.

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