Find-A-Code Articles, Published 2015, August 10

Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy

by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Aug 10th, 2015 - Reviewed/Updated May 7th

Current information on the required use of these codes and modifiers for Functional Reporting of PT, OT, and SLP services is available in the Medicare Claims Processing Manual, Chapter 5,
Section 10.6: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.PDF.

Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy, and speech-language pathology services. They should never be used with codes not on the list of applicable therapy services. For example, respiratory therapy services or nutrition therapy services shall not be represented by therapy codes that require GN, GO, and GP modifiers.

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.

There are 42 functional G-codes, 14 sets of three codes each. Six of the G-code sets generally describe PT and OT functional limitations, and eight sets of G-codes generally describe SLP functional limitations. For more information click on the link below to see a quick reference chart.

Note: Due to CY 2019 Physician Fee Schedule (PFS) rulemaking, effective for dates of service on or after January 1, 2019, Medicare no longer requires the functional reporting of non-payable HCPCS G-codes and severity modifiers − adopted to implement section 3005(g) of MCTRJCA − on claims for therapy services. For details about these payment policies, see MLN Matters article MM11120 at https://www.cms. gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11120.pdf.

UPDATE: 2020 Annual Update to the Therapy Code List

References/Resources

CMS- 2019 Release Quick Reference Chart: Descriptors of G-codes and Modifiers for Therapy Functional Reporting

About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.

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Find-A-Code Articles, Published 2015, August 10

Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy

References/Resources

About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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