Modifier for 97760

lorettac

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Miramar, Florida
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Hello to all, our podiatrist performed orthotic fittings and training during the office visit. So along with the E&M code with modifier 25, 97760 (without modifier) was added and submitted. However, Medicare denied 97760 due to inconsistent modifier. So a corrected claim with modifier 59 and KX were appended to 97760. But again Medicare denied 97760 again with the same reason "inconsistent modifier". Not sure which modifier should be appropriate to use.

Any help is greatly appreciated! Thank you very much!
 

jabeentc

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HI,

I have the same question but my claim is for physical therapist hence appended modifier GP to medicare but denied with a reason as inconsistent modifier,should i append modifier 59 along with GP.
 

michellepilcher

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Anchorage , AK
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Hi Heather
I looked up modifier 'GP' - services delivered under an outpatient physical therapy plan of care. But this claim is from a podiatrist not a physical therapist, could I use GP modifier? Thank you!

Here is what I found:


For CY 2018, the CPT Editorial Panel revised the Physical Medicine and Rehabilitation codes for a physician or other qualified health care professional (ie, therapist) required to have direct (one-on-one) patient contact to report orthotic and prosthetic management and training services by differentiating between initial and subsequent encounters. The descriptors for CPT codes 97760 and 97761 have been amended to include the term “initial encounter” and CPT code 97763 has been created in place of CPT code 97762 to describe all subsequent encounters for orthotics and/or prosthetics management and training services. The new long descriptors for CPT codes 97760 and 97761 – now intended only to be reported for the initial encounter with the patient − are listed below:

97760: Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes)
97761: Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes)


CMS will add CPT code 97763 to the therapy code list and CPT code 97762 will be deleted. Just as its predecessor code was, CPT code 97763 is designated as “always therapy” and must always be reported with the appropriate therapy modifier, GP.
 
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