Therapy Codes for DC’s and Rejected Claims
Are you noticing that you have been receiving rejected claims for physical therapy services? On January 1, 2017, the Center for Medicare and Medicaid Services (CMS) released MLN Matters Number: MM10176 a notice indicating that certain services were subject to a therapy cap and that to you must start using one of three modifiers (GN, GO, or GP). If you are not using the appropriate modifier your claims could get rejected.
THE RECENT EDIT AFFECTS THE FOLLOWING THERAPY CODES:
97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761, 97762*, 97799, G0281, G0283
If you are filing a claim with any of those affected codes it is required that the code contains the modifier GP, GY if it is performed by a Doctor of Chiropractic of their staff. Because this edit was executed by CMS and not a local carrier it will affect all chiropractic care nationwide. If your claim has been denied then you should resubmit it to Medicare, including the modifier.
For more information visit the Center for Medicare and Medicaid Services (CMS)website or view a copy of the MLN Matters Number: MM10176
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About the Author Kathy Mills Chang, MCS-P, CCPC, CCCA
Since 1983, Kathy Mills Chang has been providing Chiropractors with hands-on training, advice and tools to improve the financial performance of their practices. Kathy is a Certified Medical Compliance Specialist (MCS-P), Certified Chiropractic Professional Coder (CCPC), and a Certified Clinical Chiropractic Assistant (CCCA). She is the Founder and CEO of KMC University, THE chiropractic reimbursement and compliance experts. She leads a team of 20+ in effectively assisting providers and teams with increasing revenue and reducing risk.