LIST OF COMMON PHYSICAL THERAPY MODIFIERS
Physical therapy is a modest yet gratifying profession. However, it is undeniable that practitioners dedicate considerable time and effort to facilitate optimal patient recovery. The use of modifiers in medical billing can become quite complex, mainly when applied in the context of physical therapy.
In medical billing, modifiers are crucial for boosting precision, detail, and usefulness across all medical coding and credentialing. Modifying areas within physical therapy can significantly aid in understanding service specifics, improving the medical billing and coding process.
WHAT ARE MODIFIERS?
Modifiers are characters that extend Common Physical Therapy (CPT) Level II codes. They provide additional information about medical procedures, services, or supplies. However, they do not alter the code and only provide added details about the encounter.
Physical therapists can apply modifiers to modify the medical codes for various conditions, showing that a service was carried out differently. Modifiers also provide details that are not apparent from the code descriptor. They assist in recording the alteration of the procedure so that providers can receive the correct payment.
Modifiers enhance medical billing by making claims more exact, which helps speed up claims processing and prevents denials. Knowing about different modifiers and how to apply them correctly is crucial for accurate medical billing. If you use an incorrect modifier, your claim might be rejected, or there could be delays in reimbursements, which can result in a loss of revenue.
TYPES OF PHYSICAL THERAPY MODIFIERS
CPT MODIFIERS
CPT modifiers are two-digit codes that often appear when billing Medicare and commercial insurance. The copyright for these belongs to the American Medical Association (AMA). In medical billing, physical therapy modifiers are a standard CPT modifier. Some of them include:
MODIFIER 59
Without a doubt, physical therapy is a great career, although it does require a lot of patience. The practitioners put considerable effort into ensuring the rehabilitees arrive at their best possible recovery. Nevertheless, the application of modifiers in physical therapy medical billing is quite intricate.
You might need to utilize Modifier 59 when caring for a patient and charging separately for 15 minutes of manual therapy (97140) and another 15 minutes for therapeutic activities (97530). Incorporating modifier 59 into your CPT code will assist in guaranteeing reimbursement for both services despite them being done on the same day.
LEVEL II HCPCS (HEALTHCARE COMMON PROCEDURE CODING SYSTEM) MODIFIERS
HCPCS Level II modifiers are codes that consist of both letters and numbers. They are added when billing for Medicaid, Medicare, or specific commercial plans. These modifiers fall under the control and management of the Centers for Medicare & Medicaid Services (CMS). The most frequent Level II HCPCS modifiers are:
GP MODIFIER
The GP Modifier is most often employed in inpatient and outpatient situations. It shows a service or treatment within a physical therapy care plan. Applying the GP modifier on the precise line item denotes that an authorized physical therapist performed this service.
Another comparison can be seen in how occupational and physical therapists bill the CPT Code 97110. The GP code sets apart which provider is giving this service to prevent confusion.
CQ/CO MODIFIER
The CQ or CO modifier clarifies if the service is given as a complete unit, partially by the physical or occupational therapist assistant.
CQ Modifier: This code shows if the physical therapy services given in an outpatient setting were done entirely or partially by a physical therapist assistant.
CO Modifier: The CO Modifier is used for outpatient occupational therapy services provided by an occupational therapist assistant either entirely or partially.
KX MODIFIER
When a patient exceeds Medicare’s threshold, the KX Modifier is applied. It signifies that the requirements as per the payer-specific medical policy have been fulfilled. The therapist must demonstrate through appropriate paperwork that this treatment is crucial. A patient could be presented as someone who needs a specific treatment but has reached the limit for another medically needed procedure.
GA MODIFIER
The GA Modifier is utilized to indicate that a medical service is not needed. In this situation, an Advance Beneficiary Notice of Noncoverage (ABN) would be filed to notify the patient that Medicare will not cover the medical services they are about to receive. This permits the therapist to bill either a secondary provider or the patient directly.
CONCLUSION
Physical therapy is not only necessary for patient recovery but also quite rewarding to the practitioners. Unfortunately, modifiers, often used in medical billing, are very complicated, but mastering them is essential because only then will therapists be able to concentrate on reaching their target: the patients’ recovery. Being in a position where you must be rewarded while also facing difficulties in the profession provides excellent opportunities for growth and success to pursue within the profession.
