# Need Modifier for Physical Therapy Codes



## ckirkp1

Hello to all, I'm new at coding outpt physical therapy (ORF) and need to know what modifier to use 59 or GP?  We recvd a denial from Humana Gold for missing modifier the codes we billed:

97001, G0283, 97110, & 97140

And also on a seperate claim the same thing denied but we only billed out one code:

97113 

Any help is greatly appreciated!!!


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## charissesimone

ckirkp1 said:


> Hello to all, I'm new at coding outpt physical therapy (ORF) and need to know what modifier to use 59 or GP?  We recvd a denial from Humana Gold for missing modifier the codes we billed:
> 
> 97001, G0283, 97110, & 97140
> 
> And also on a seperate claim the same thing denied but we only billed out one code:
> 
> 97113
> 
> Any help is greatly appreciated!!!



HI! 
You need to submit claim with ICD-9 (Diagnosis) & CPT Code with proper modifier , but make sure it's "Medically Necessary"( means patient must have a valid reason why service or procedure was done patient. MediCare are sticklers & wan't proof rendered med services.


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## ckirkp1

My question is what modifier to use?


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## pjorwin

I have billed PT, OT and St for years and I would normally use GP with an HMO. Sometimes managed care plans do not want modifiers unless their system is capable of processing payment with them. I know with Medicare you can use more than one modifier but Humana does process claims differently.


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## Chelle-Lynn

I agree with the GP and GO modifier for Humana.  You want to be very careful with the use of modifier 59.


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## thar1995

*Physical Therapy billing*



pjorwin said:


> I have billed PT, OT and St for years and I would normally use GP with an HMO. Sometimes managed care plans do not want modifiers unless their system is capable of processing payment with them. I know with Medicare you can use more than one modifier but Humana does process claims differently.



Hello, I need help billing Physical Therapy.  
The practice enters the charges and puts GP mod on all items.  They said to put a 59 mod on 97112 when it was denied by medicare for B-15 -Service/Procedure requires that a qualifying service/procedure be recieved and covered. 
97760 was denied for benefit maximum for time period has been reached. 
Original claim had pre-authorized tracking number on it.  Medicare forwarded claim to secondary BCBS.
Added 59 to 97112/59/GP, re-filed.

BCBS paid 97760 but not 97112.

Medicare denied both 97112 & 97760 for benifit maximum reached. 
Added KX modifier to both 97112/59/KX & 97760/KX. 

Medicare denied 97112 for Procedure code inconsistant with modifier used or required modifier is missing.
What is the correct way to bill this, please?
Thanks


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## blnord

ckirkp1 said:


> Hello to all, I'm new at coding outpt physical therapy (ORF) and need to know what modifier to use 59 or GP?  We recvd a denial from Humana Gold for missing modifier the codes we billed:
> 
> 97001, G0283, 97110, & 97140
> 
> And also on a seperate claim the same thing denied but we only billed out one code:
> 
> 97113
> 
> Any help is greatly appreciated!!!



Humana Gold is a Medicare replacement policy therefore you would bill it exactly as you would bill Medicare (ie; GP modifier's and G0283 instead of 97014 as you did)


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