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GP, Physical Therapy Mods for medicaid plans?

  1. Default GP, Physical Therapy Mods for medicaid plans?
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    Hello all,

    We've been getting some denials from Fidelis for missing modifiers for physical therapy - in particular, the GP modifier. I was always under the impression that the GP or GO modifiers (for physical therapy) were only used for straight Medicare and Medicare-managed plans, but a rep at Fidelis is saying that for 2017, this requirement changed to include Medicaid plans as well.

    Would anyone be able to verify this and show any documentation of this change? I've tried to look on CMS myself, but was unable to find something that states that the requirement of the GP modifier has been changed to include Medicaid plans as well.

    Thank you!

  2. #2
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    If your payers is requiring the modifiers you should add them,please note Medicaid is administered at the state level and each state can have different requirements so you wont find any guidance at the national level. Maybe Fidelis can provide you with or direct you to a copy of their policy.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  3. #3
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    Columbia, MO
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    Are you certain it is the GP or GO modifiers you are missing? or maybe it is the functional status modifiers? Have you included the functional status modifiers already? If not I would look at those as the ones they are wanting.

    Debra A. Mitchell, MSPH, CPC-H

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