Table of Contents

What is GP Modifier?

The GP modifier indicates that a physical therapist’s services have been provided. It’s commonly used in inpatient and outpatient multidisciplinary settings. It’s also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers. Be aware that some payers require use of a therapy modifier when billing for a designated therapy code.

The Medicare GP modifier refers to a Medicare billing code under the current Healthcare Common Procedure Coding System. This coding system is an industry standard for billing Medicare. These codes are designed and implemented by the Centers for Medicare & Medicaid Services, which is the federal regulating agency that oversees Medicare.

According to the Centers for Medicare and Medicaid Services, a GP modifier means that “Services [are] delivered under an outpatient physical therapy plan of care.” This means that the service or item received was a part of a preexisting plan of care for physical therapy created by Medicare doctors and physical therapists. It also means that the service was performed in an outpatient setting. Put another way, the patient did not need to be admitted to a hospital to obtain the service. In order for physical therapy to be covered by Medicare, a plan of care is required.

Use of 25 & 27 Modifier

Use of 58 and 78 Modifier

Use of 22 and 23 Modifier

Use of 26 and TC Modifier

Example for use of GP modifier

Use a GP modifier in any case where there could be confusion as to which provider delivered services to a patient, such as in any interdisciplinary therapy setting.

According to CMS, certain codes are ‘Always Therapy’ services no matter who performs them and require a therapy modifier (GP, GO, or GN) to indicate they are provided under physical therapy, occupational therapy, or speech-language pathology plan of care.

‘Always Therapy’ modifiers are required for accurate reimbursement for each distinct type of therapy in accordance with member group benefits.

GP is the most appropriate for chiropractic claims, as it aligns with the therapy provider “physical therapy”.

This does not mean Medicare is paying chiropractic providers for therapy; however, GP is a necessary modifier to assure a proper denial for a secondary payer to make payment.

Contractors edit institutional claims to ensure the following:
• that a GN, GO or GP modifier is present for all lines reporting revenue codes 042X, 043X, or 044X.
• that no more than on e GN, GO or GP modifier is reported on the same service line.

That revenue codes and modifiers are reported only in the following combinations:
• Revenue code 42x (physical therapy) lines may only contain modifier GP
• Revenue code 43x (occupational therapy) lines may only contain modifier GO
• Revenue code 44x (speech – language pathology) lines may only contain modifier GN.
• that discipline – specific evaluation and re – evaluation HCPCS codes are always reported with the modifier for the associated discipline (e.g. modifier GP with a HCPCS code for a physical therapy evaluation.

Coding Scenario

A patient with patellofemoral pain seeks treatment. At the beginning of the patient’s appointment, the clinic PTA provides 13 minutes of therapeutic exercise (CPT 97110), after which the PT provides manual therapy (CPT 97140) for 22 minutes. Then the PT leads the patient through 15 more minutes of therapeutic exercise.

Final Modifiers: