Wiki wheelchair management

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alh728

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Hello All,

I have a PCP who is billing 97542/wheelchair management. Medicare denied the claim indicating a modifier is required. Being this is generally an OT/PT code I'm assuming they're looking for a 'GO' or 'GP' modifier, however I am having a hard time finding any guidance on alternative modifiers to use for a case like this when it is a PCP performing the service. Can anyone advise?

TIA!
 
The patient may be evaluated to determine what kind of wheelchair would be appropriate, or the patient may receive training on use of the wheelchair. The provider assesses wheelchair appropriateness and safe use (stability, balance, pressure management) based on the patient's functional abilities/goals. The provider is present for the treatment. This code reports 15 minutes of treatment.

Report with modifiers -GP or -GO to indicate service is part of a plan of care.
 
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