Wiki Need Modifier for Physical Therapy Codes

ckirkp1

Networker
Messages
58
Best answers
0
Hello to all, I'm new at coding outpt physical therapy (ORF) and need to know what modifier to use 59 or GP? We recvd a denial from Humana Gold for missing modifier the codes we billed:

97001, G0283, 97110, & 97140

And also on a seperate claim the same thing denied but we only billed out one code:

97113

Any help is greatly appreciated!!!
 
Hello to all, I'm new at coding outpt physical therapy (ORF) and need to know what modifier to use 59 or GP? We recvd a denial from Humana Gold for missing modifier the codes we billed:

97001, G0283, 97110, & 97140

And also on a seperate claim the same thing denied but we only billed out one code:

97113

Any help is greatly appreciated!!!

HI!
You need to submit claim with ICD-9 (Diagnosis) & CPT Code with proper modifier , but make sure it's "Medically Necessary"( means patient must have a valid reason why service or procedure was done patient. MediCare are sticklers & wan't proof rendered med services.
 
I have billed PT, OT and St for years and I would normally use GP with an HMO. Sometimes managed care plans do not want modifiers unless their system is capable of processing payment with them. I know with Medicare you can use more than one modifier but Humana does process claims differently.
 
I agree with the GP and GO modifier for Humana. You want to be very careful with the use of modifier 59.:)
 
Physical Therapy billing

I have billed PT, OT and St for years and I would normally use GP with an HMO. Sometimes managed care plans do not want modifiers unless their system is capable of processing payment with them. I know with Medicare you can use more than one modifier but Humana does process claims differently.

Hello, I need help billing Physical Therapy.
The practice enters the charges and puts GP mod on all items. They said to put a 59 mod on 97112 when it was denied by medicare for B-15 -Service/Procedure requires that a qualifying service/procedure be recieved and covered.
97760 was denied for benefit maximum for time period has been reached.
Original claim had pre-authorized tracking number on it. Medicare forwarded claim to secondary BCBS.
Added 59 to 97112/59/GP, re-filed.

BCBS paid 97760 but not 97112.

Medicare denied both 97112 & 97760 for benifit maximum reached.
Added KX modifier to both 97112/59/KX & 97760/KX.

Medicare denied 97112 for Procedure code inconsistant with modifier used or required modifier is missing.
What is the correct way to bill this, please?
Thanks
 
Hello to all, I'm new at coding outpt physical therapy (ORF) and need to know what modifier to use 59 or GP? We recvd a denial from Humana Gold for missing modifier the codes we billed:

97001, G0283, 97110, & 97140

And also on a seperate claim the same thing denied but we only billed out one code:

97113

Any help is greatly appreciated!!!

Humana Gold is a Medicare replacement policy therefore you would bill it exactly as you would bill Medicare (ie; GP modifier's and G0283 instead of 97014 as you did)
 
Top