Did you know that other than the traditional modifiers, there are separate therapy modifiers that help specify the complexity and extent of the rendered care procedure? If this is something new to you, or if you have trouble understanding how to use therapy modifiers accurately, this guide is for you!
In this guide, we will discuss one of the important therapy modifiers, the GP modifier for physical therapy. We will try to cover all aspects of this modifier, from sharing some practical scenarios for its application to its usage guidelines for rightful reimbursement.
So, without further ado, let’s get started!
What is a GP Modifier?
The GP modifier in medical billing is typically appended to indicate to the insurance payer that a qualified physical therapist performed a specific therapy service under an outpatient physical therapy plan.
This modifier must be used with the relevant CPT code that describes the care service accurately. Besides, it is used to differentiate physical therapy services from other therapies, such as speech-language pathology and occupational therapy services. When it is established that a physical therapist has rendered the service in an outpatient setting, rightful payments are released by Medicare and other payers.
Important Note: The GP modifier is required by Medicare, but the billing requirement for private insurance plans may vary. Thus, we recommend you review the specific payer guidelines before billing the therapy services.
The following are some of the settings where this modifier may apply:
- Federally qualified health centers (FQHCs) and community health centers (CHCs)
- Comprehensive outpatient rehab facilities (CORFs)
- Home health agencies
- Hospital outpatient departments
- Private practices
- Skilled nursing facilities (SNF)
Here’s a quick table to give you an overview of important therapy modifiers other than the GP modifier for physical therapy:
| Service Type | Performing Provider | Modifier |
|---|---|---|
| Physical Therapy | Licensed Physical Therapist | GP |
| Occupational Therapy | Licensed Occupational Therapist | GO |
| Speech-language Pathology | Licensed Speech-language Pathologist | GN |
| Physical Therapy | Assistant Physical Therapist | CQ |
| Occupational Therapy | Assistant Occupational Therapist | CO |
Important Note: Failure to append the GP modifier can lead to claim rejections, incorrect payment, and non-compliance with payer guidelines, leading to audits and penalties. Besides, these repercussions create a snowball effect, impacting the overall revenue cycle of your physical therapy practice.
Scenarios Where a GP Modifier is Applicable
Here are some scenarios to help you gauge where to append this modifier:
Functional Limitation Reporting (FLR)
What happens when a physical therapist assesses a patient’s functional limitations who recently experienced a spinal cord injury? The therapist must append the GP modifier to indicate to the payer that a physical therapist rendered the service as part of the FLR. Besides, the therapist must also report G-codes and severity modifiers to ensure accurate reimbursements.
Outpatient Physical Therapy
Assume a patient visits a physical therapist after knee replacement surgery to speed up recovery. The therapist directs therapeutic exercises depending on the patient’s stage of recovery and specific needs. Here, the healthcare provider must append the GP modifier to the CPT code 97110 to highlight that a physical therapist rendered the service.
Home Health
A physical therapist visited the patient with a hip fracture at his home to conduct therapeutic activities aimed at restoring function and preventing future falls. Thus, the claim must include the GP modifier with the CPT code 97530 to specify that the service was performed by a physical therapist.
Best Practices for Using GP Modifier for Physical Therapy
Discussed below are medical billing best practices for using the GP modifier while reporting physical therapy services:
Accurate Service Identification
You must ensure that the therapy services you want to bill are rendered by a qualified physical therapist. If the services are performed by any other qualified healthcare professional, the GP modifier for physical therapy will not apply.
Moreover, verify that the services fall under the scope of physical therapy, which typically includes but is not limited to rehabilitation, manual therapy, therapeutic exercises, neuromuscular reeducation, and gait training.
Refer to the following table for more details:
| Service Type | Modifier | Revenue Code |
|---|---|---|
| Physical Therapy | GP | 042X |
| Occupational Therapy | GO | 043X |
| Speech-language Pathology | GN | 044X |
For the unversed, revenue codes are added to the claim in conjunction with the relevant therapy modifiers to specify charges for a specific service. Thus, if a physical therapist rendered the services, you must incorporate its appropriate revenue code in the claim with the GP modifier, which is 042X.
Ensure Comprehensive Documentation
Documentation is key to ensuring faster processing of claims with a GP modifier for physical therapy. Thus, you should strive to record and include details about services provided in each therapy session, time spent on providing these services, the progress of the patient, and any amendments to the proposed treatment plan.
Besides, your documentation must support the use of the GP modifier. In case the healthcare therapy limit is near, but the therapist believes that the treatment should be continued, you must provide evidence establishing the medical necessity and appropriateness of it.
Leverage EHR System
Utilizing advanced technology systems, such as electronic health records (EHR) and billing software, can help you streamline physical therapy billing. Integrating these systems will help you mitigate error frequency, such as data entry errors, wrong code selection, diagnosis-procedural code mismatch, inappropriate GP modifier usage, etc. When mistakes are eliminated, the claim first-pass rate increases, the denial rate decreases, and you experience a healthier revenue cycle.
Adhering to Payer Guidelines
Compliance with the varying payer guidelines across different insurance companies is essential when appending the GP modifier in medical billing. Besides, the payer billing requirements and reimbursement policies change over time. Thus, we recommend training your billing team to stay current on these changes to ensure accurate reporting of therapy services, faster claim processing, and fewer claim denials.
When Not to Use the GP Modifier?
Discussed below are some of the scenarios where using this modifier is inappropriate:
- The therapy plan does not contain the services rendered by the therapist. For example, if the physical therapist provided general health advice or performed other non-therapy-related care services, you should only report their relevant CPT code without appending the GP modifier.
- Avoid using this modifier if the specific therapy service was performed in an inpatient setting, such as during the patient’s stay at a skilled nursing facility (SNF) or hospital.
- Do not append the GP modifier if the physical therapist rendered the therapy services under a different type of care plan, such as speech-language pathology or occupational therapy plan of care.
- Do not add this modifier if the performed therapy is part of a bundled service.
Summary
Let’s quickly summarize what we learned in this guide! We explained that the GP modifier in medical billing is used when therapy services are performed by a licensed physical therapist in an outpatient facility, including a home health agency, SNF, CORF, FQHC, etc. Besides, we discussed some scenarios where this modifier is applicable.
We also mentioned billing best practices to help ensure accurate usage of this modifier for rightful reimbursements. These best practices include service identification, comprehensive documentation, compliance with payer guidelines, and EHR integration.
We hope these details will help you up your medical billing game, leading to higher reimbursements. However, if you find it challenging to do it in-house, we recommend outsourcing physical therapy billing services to professionals like MediBillMD.
