# PT denial 97001/GP, 97110/GP, 97140/GP



## glittersparklz (Dec 7, 2015)

Hello,

We received a denial from Medicare for PT services 97001/GP, 97110/GP X2, & 97140. The denial code states that payment for 97110/GP x2 & 97140/GP are included in the allowable for another procedure.

I have been researching CMS rules on submitting these codes together and am drawing a blank. Any insight would be greatly appreciated, thanks!


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## mitchellde (Dec 7, 2015)

Typically you cannot bill the evaluation on the same day as the modalities.  Check your CCI edits.


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## glittersparklz (Dec 7, 2015)

Thanks Debra! Do you happen to have a link to the info you located? I cannot find anything that applies in the CCI edits.


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## honeybee (Dec 7, 2015)

You probably need to apply functional limitation reporting info in order to get the claim paid. None of those codes are typically bundled but I suppose depending on your MAC they may want a 59 modifier on 97001. We do not usually need to apply the 59 when billing these codes together. 

Missy Lupercio
Spooner PT


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## glittersparklz (Dec 8, 2015)

Thanks Missy, I think that is the issue! Looks like the office forgot to add the functional G-codes


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## mitchellde (Dec 8, 2015)

I read this many years ago in a newsletter from decision health.  I always had issues getting reimbursement for an evaluation and modalities on the same day.  Since I read the article I stopped the therapists from doing this and no problems since then.  I have talked with many others that code for rehab and they also had the same problem every time they tried to bill an evaluation with a modality.  But then again it could just be the modifies as suggested. Try that and see.


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## kivbar16 (Dec 17, 2015)

Anytime you have an evaluation (97001) or re-evaluation (97002), you must use Functional Limitation (G) codes.  There should not be any other issue with your claim; only time you need a 59 modifier is w/ the re-evaluation code.  (As an aside, you would also need G codes on every 10th visit.)


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