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Modifier for coding Physical Therapy

  1. Default
    Medical Coding Books
    In my state of Illinois, a medical doctor or a physical therapist may provide and bill the physical medicine procedures. Perfectly legal.

  2. #12
    White Plains, NY
    Default Probably not
    Only if the Doc is a licensed PT:

    (225 ILCS 90/2) (from Ch. 111, par. 4252)
    (Section scheduled to be repealed on January 1, 2016)
    Sec. 2. Licensure requirement; exempt activities. Practice without a license forbidden ‑ exception. No person shall after the date of August 31, 1965 begin to practice physical therapy in this State or hold himself out as being able to practice this profession, unless he is licensed as such in accordance with the provisions of this Act. After the effective date of this amendatory Act of 1990, no person shall practice or hold himself out as a physical therapist assistant unless he is licensed as such under this Act. A physical therapist shall use the initials "PT" in connection with his or her name to denote licensure under this Act, and a physical therapist assistant shall use the initials "PTA" in connection with his or her name to denote licensure under this Act.


  3. Default
    When billing medicare and medicaid for physical medicine codes, you must use modifier GP for physical therapy and GO for occupational therapy. Check with your state licensing board prior to using these codes for someone other than a PT or OT. Also, medicare does not pay for hot/cold packs, but most private insurance companies do. You do not use any other modifiers for these codes.

  4. #14
    Default PT for 97022 and 97124 together plus modifiers
    We are outpt PT. We have a tx plan approved by an MD. Our PTA performed the therapy under the supervision of a PT. THis is not a medicare plan. My chosen CPT codes are 97022 and 97124. It is a hip problem. Do we need a modifier 59 on the second code? And, do we need to use the GP modifier on one or both of the codes? Any feedback?

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