Outpatient physical and occupational therapy services, and speech-language pathology services must be submitted with the appropriate HCPCS modifiers when these services are provided as part of a therapy plan of care. Therapy services that are submitted without the required modifier are "returned as unprocessable" (remark code MA130) and must be corrected and resubmitted as new claims.
Therapy Modifier Requirements
- Therapy services provided by physicians, nonphysician practitioners, physical and occupational therapists, and speech language pathologists in private practice must be submitted with the appropriate modifier (HCPCS modifier GP, GN or GO) when the services are performed under a therapy plan of care
- HCPCS modifier GP — Services delivered under an outpatient physical therapy plan of care
- HCPCS modifier GN — Services delivered under an outpatient speech-language pathology plan of care
- HCPCS modifier GO — Services delivered under an outpatient occupational therapy plan of care
- A list of codes that require therapy modifiers is available on the CMS Therapy Services web page
Note: These modifiers may apply to other services that are furnished by therapists or provided under a therapy plan of care, depending upon the site of service (e.g., application of casts and strapping).
Therapy Services Provided by Chiropractors
- Therapy services provided by chiropractors are non-covered
- Because these services are excluded from coverage by law ("statutorily excluded" from coverage), chiropractors are not required to submit claims for therapy services to Palmetto GBA
- If the patient requests that the claim be submitted, these services must be submitted with the appropriate HCPCS modifier (GP, GN or GO) and HCPCS modifier GY. Therapy services submitted without the appropriate modifier will be returned as unprocessable.
- Therapy codes that require "plan of care" modifiers
Annual Therapy Update
(Select the current file from the "Download" section at the bottom of the webpage.)