Outpatient Rehabilitation Modifiers

by  Jared Staheli, MPP
Jan 9th, 2018

Modifiers are used for outpatient rehabilitation services to identify the type of service performed. This is necessary for payers to determine service coverage for beneficiaries.

For services delivered under an outpatient plan of care use modifier:

• GN for speech-language pathology
• GO for occupational therapy
• GP for physical therapy

In addition to using the correct modifier, the provider must still be qualified to deliver the service. For example, adding modifier GP to a service performed by a non-qualified practitioner will not make the service payable.

These modifiers need to be used for any applicable physical therapy, occupational therapy, or speech-language pathology services. However, there are some codes that should not be billed with therapy modifiers, which include:

• G0237 “Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)”
• G0238 “Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)”
• G0239 “Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)”
• 95860 “Needle electromyography; 1 extremity with or without related paraspinal areas”
• 95861 “Needle electromyography; 2 extremities with or without related paraspinal areas”
• 95863 “Needle electromyography; 3 extremities with or without related paraspinal areas”
• 95864 “Needle electromyography; 4 extremities with or without related paraspinal areas”
• 95867 “Needle electromyography; cranial nerve supplied muscle(s), unilateral”
• 95869 “Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12)”
• 95870 “Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters”

See the Medicare Claims Processing Manual, Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services, Section 20