Medicare and several other insurance payers have set annual therapy limits for their beneficiaries. These thresholds ensure that only the most medically necessary outpatient therapies are rendered to patients. However, the therapies may range from occupational to physical to speech-language. So, how will the provider ensure that the therapy service’s discipline is identified accurately for proper claim processing and reimbursement? The answer lies in using the correct therapy modifier.
For today, we will limit our discussion to the GN modifier. So, if you are curious about the modifier’s description, applicable scenarios, and billing guidelines, scroll down to read the details.
GN Modifier – Description
The GN modifier is a Healthcare Common Procedure Coding System (HCPCS) modifier that was released by Medicare to indicate that the service was rendered under an outpatient speech-language pathology plan of care.
It is a part of therapy modifiers that were introduced in 2003 to help payers differentiate between occupational therapy, physical therapy, and speech or language therapy services. Still unclear, let us explain.
- GN modifier: Services delivered under an outpatient speech-language pathology plan of care.
- GO modifier: Services delivered under an outpatient occupational therapy plan of care.
- GP modifier: Services delivered under an outpatient physical therapy plan of care.
Note that all three modifiers listed above are informational and do not have an effect on the reimbursement rate of the services. Moreover, Medicare, as well as many private payers, enforce the use of the modifier GN with speech and language pathology therapy codes. So, speech-language pathologists (SLPs) and speech-language technicians (SLTs) must be mindful of this billing requirement.
Scenarios Where a GN Modifier is Applicable
Generally speaking, this modifier can be applied to a range of speech therapy service codes, such as those representing individual and group therapies, evaluations, and caregiver training. However, to understand the accurate application of the GN modifier to procedural codes, let’s discuss some real-world clinical scenarios.
Evaluation of the Swallowing Function
Imagine that a 70-year-old stroke survivor visits an outpatient speech and language therapy clinic, complaining of choking and coughing on food. He says that he faces difficulty swallowing food, which is leading to painful meal times and weight loss. The SLP performs a comprehensive evaluation of the inside of the patient’s mouth, the voice box, and the food pipe using a videofluoroscopic swallow study (VFSS) to check the swallowing function (deglutition) in real time.
The imaging results reveal pharyngeal muscle weakness, delayed or incomplete laryngeal elevation, and reduced tongue propulsion. Hence, the patient is diagnosed with oropharyngeal dysphagia, and the evaluation is billed using CPT code 92611 with the GN modifier appended to it for coding specificity.
Treatment of Communication and Auditory Processing Disorder
For our second example, imagine that the SLP meets three children between the ages of 5 and 8 who have been diagnosed with communication and hearing disorders. Two of them have speech impediments and stutter while speaking, whereas the third one suffers from an auditory processing disorder (APD).
Therefore, the SLP performs a combined or group therapy by directly interacting with patients, improving their ability to make sounds, and identifying their auditory response. Here, CPT code 92508 will be used for billing, and the GN modifier will be appended to the procedural code to indicate an outpatient speech-language pathology service.
GN Modifier – Billing Guidelines
Are you using modifier GN on your speech and language therapy claims and still receiving a denial? Then, maybe it has more to do with how you are using the GN modifier rather than using or not using it.
There are certain billing rules that you must adhere to when appending this modifier to ensure its appropriate usage and clean claim submission on the first try. Take a look.
Understand Who Can Use Modifier GN
First, and most importantly, you must be aware of the practitioners who are allowed to use the GN modifier for reimbursement of their services. These include:
- Speech-Language Pathologist (SLP): A certified and licensed speech therapist who diagnoses and treats communication and swallowing disorders in people of all ages.
- Speech-Language Technician (SLT): A technician with a relevant Bachelor’s degree who supports the work of an SLP, such as preparing materials, conducting screenings, and implementing therapy plans.
- Speech-Language Pathologist Assistant (SLPA): An assistant with a relevant Bachelor’s degree and supervised clinical experience who also assists the SLP in evaluations, screenings, and treatments.
- Speech-Language Pathology Student: A student of speech-language pathology who is yet to obtain a Master’s degree in SLP, but must complete the necessary coursework.
Remember that all the relevant supervision requirements must be met when assistants, students, or technicians render the SLP service in an outpatient setting. Only then will the use of modifier GN be considered appropriate on the claim forms.
Understand When to Use Modifier GN
You must also ensure that the GN modifier is only used when:
- An individual SLP therapy session occurs.
- A group SLP therapy session occurs.
- The provider performs speech and language evaluations.
- The provider performs Augmentative and Alternative Communication (AAC) evaluations.
- The provider performs swallowing evaluations and therapies.
Report with the Correct POS Code
Place of Service (POS) codes are entered on the claim forms to specify the setting in which the service was rendered. For the modifier GN to be applicable, the setting must be an outpatient clinic, private practice, hospital-affiliated center, or the patient’s home.
Therefore, the POS codes that support the GN modifier’s usage include:
- POS 11: Physician’s office
- POS 12: The patient’s home
- POS 19: Off-campus outpatient hospital
- POS 22: On-campus outpatient hospital
- POS 49: Independent clinic
- POS 62: Comprehensive outpatient rehabilitation facility
Check if the Modifier’s Usage is Limited to a Few Codes
Every payer, whether government or commercial, will have its own unique rules when it comes to billing with the modifier GN. So, we suggest that you read each payer’s policy manual thoroughly and verify whether the modifier is only applicable to a few specific codes. For example, the Kansas Medical Assistance Program (KMAP) has restricted the GN modifier’s usage to the following codes:
0019T, 0029T, 0183T, 64550, 90901, 92520, 92506, 92507, 92508, 92526, 92597, 92605, 92606, 92607, 92608, 92609, 92610, 92611, 92612, 92614, 92616, 95831, 95832, 95833, 95834, 95851, 95852, 96105, 96110, 96112, 96113, 96125, 97010, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97597, 97598, 97602, 97605, 97606, 97750, 97755, 97760, 97761, 97762, 97799, G0281, G0283, G0329, and G0515.
Include Adequate Documentation
Your supporting documentation will help the insurance payer gauge the medical necessity of the SLP service. Therefore, you must ensure that your documentation for the GN modifier clearly highlights the clinical indications for the service (such as auditory disorder or dysphagia), the treatment plan, the outpatient setting, and the credentials and signature of the therapist, along with the patient’s complete medical record and therapy notes.
Ensure the Correct Modifier Sequencing
Another important point to consider is the placement of your GN modifier. As we have mentioned before, GN is an informational modifier and does not have an impact on the reimbursement rate. So, as per the billing rules, the correct sequencing of modifiers is as follows:
- 1st Place: Pricing modifier, e.g., 22, 26, 50, 52, and 53.
- 2nd Place: Payment modifier, e.g., 24, 25, 51, 59, and 77.
- 3rd Place: Informational or statistical modifier, e.g., GN, GP, GO, 95, and GT.
- 4th Place: Location modifier, e.g., RT, LT, T1-T9, and F1-F9.
So, if a situation arises where you are required to append two modifiers to the procedural code, the correct coding will be as follows:
92507-59-GN
Where 92507 is the CPT or procedural code, 59 is the payment modifier, and GN is the informational modifier.
Bottom Line
With that said, we have reached the end of our detailed guide on the GN modifier. To reiterate, this modifier explains to the insurance payer that the rendered service was part of an outpatient speech-language pathology therapy plan.
SLPs and their assistants can append this modifier to the relevant SLP therapy codes to ensure billing accuracy and faster claims processing. However, you must remember to adhere to the billing guidelines mentioned above, such as including comprehensive documentation and ensuring the correct modifier sequencing.
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