20.1 - Discipline Specific Outpatient Rehabilitation Modifiers - All Claims (Rev. 11129, Issued: 11-22-21, Effective: 01-01-22, Implementation: 01-03-22) Modifiers are used to identify therapy services whether or not financial limitations are in effect. When limitations are in effect, the CWF tracks the financial limitation based on the presence of therapy modifiers. Providers/suppliers must continue to report one of these modifiers for any therapy code on the list of applicable therapy codes except as noted in §20 of this chapter. Consult §20 for the list of codes to which modifiers must be applied. These modifiers do not allow a provider to deliver services that they are not qualified and recognized by Medicare to perform. The claim must include one of the following modifiers to distinguish the discipline of the plan of care under which the service is delivered:
• GN Services delivered under an outpatient speech-language pathology plan of care;
• GO Services delivered under an outpatient occupational therapy plan of care; or,
• GP Services delivered under an outpatient physical therapy plan of care.
Contractors edit institutional claims to ensure the following:
• that a GN, GO or GP modifier is present for all lines reporting revenue codes 042X, 043X, or 044X.
• that no more than one GN, GO or GP modifier is reported on the same service line.
• that revenue codes and modifiers are reported only in the following combinations:
o Revenue code 42x (physical therapy) lines may only contain modifier GP
o Revenue code 43x (occupational therapy) lines may only contain modifier GO
o Revenue code 44x (speech-language pathology) lines may only contain modifier GN.
• that discipline-specific evaluation and re-evaluation HCPCS codes are always reported with the modifier for the associated discipline (e.g. modifier GP with a HCPCS code for a physical therapy evaluation)
CMS has established two modifiers, CQ and CO, for services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs). The modifiers are defined as follows:
• CQ modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
• CO modifier: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant