Wiki Physical Therapy

[companey]

Hello,

Physical Therapy is a new area for me and I was given a question from one of my members from the billing team about Denial from the Insurance Company. They billed for DOS: 05/11/2017 CPT codes 97110, 97116, G8978 DOS: 05/17/2017 97110, 97116, 97140, G8979, G8980. They are denying for Modifier missing & not properly paired G codes? Can someone please tell me where to start looking? Do you have a link? want to see if we can correct before the 1 year deadline.

Thanks in Advance!!!

 

[Jess31]

I'm assuming the payer is Medicare? If so, each CPT code, including the FLR codes, must have a GP (physical therapy only) modifier.
The functional limitation codes could also be missing the severity modifiers (CH, CI, etc.)
Below is a link to some good information regarding FLR codes, from WebPT, which specializes in Physical/Occupational/Speech therapy.

https://www.webpt.com/g-codes

Good luck!