Wiki PT evaluations

[kdg925cpc]

PT evaluations (97161, etc.) are denying for incomplete/invalid modifiers. Multiple payers. Codify indicates that the GP modifier is valid - so why do these keep denying?

 

[amyjph]

The payer may not want it. Did you check the individual guidelines/policy for those that are denying it? Is it denying by the payer or is it rejecting in the clearinghouse? Most payers want the GP on everything physical therapy following CMS, but some might not on the eval. Have you tried removing it? Is the name on the claim and billing provider a PT? Is everything else correct on the claim? Does it require another modifier at all? Are there other codes on the same claim?

 

[JSwise]

PT evaluations (97161, etc.) are denying for incomplete/invalid modifiers. Multiple payers. Codify indicates that the GP modifier is valid - so why do these keep denying?

PT Evaluations require a 59 Modifier along with the GP. Hope this helps.