# Physical Therapy 97001 Denied by Medicare



## cwilson3333 (Mar 2, 2015)

New to physical therapy billing.

Need some guidelines when billing Medicare 97001 , PT evaluation and treatment same date, i.e. 97140, 9730, 97710.

Am told by my AR person, that Medicare is rejecting/denying  97001.
No problem with commercial insurances. Always put GP modifier on these codes.

Help


----------



## Wendy McBride (Mar 2, 2015)

Did you also add the functional G codes? Medicare will always deny 97001 and 97002 unless the functional G codes are also attached... That also applies to the Medicare replacement plans...


----------



## xray_amy2003@yahoo.com (Mar 3, 2015)

Hi Wendy,

I am new to coding for PT.  We have also been getting Medicare denials for 97001.  You mentioned we need to use a function G-code as well.

So are you saying we need to first code 97001 with a modifier GP and then on the next procedure line, code a G-code with the appropriate modifier? ie... CI, CJ

Am I understanding this correctly?

Thank you for your help!

Amy


----------



## amyjph (Mar 3, 2015)

http://www.cms.gov/outreach-and-edu...k-mln/mlnmattersarticles/downloads/se1307.pdf

Please read this from CMS above.

Regarding Wendy's comment about it being applicable to MCR replacement plans, we have not seen this to be the case, only MCR.

In May 2014 UHC MCR Solutions announced that they would require the Functional Codes August 1 however, rescinded this & it was never implemented.

From APTA:  http://www.apta.org/PTinMotion/News/2014/8/4/UHCDelaysFLR/


----------

