tci Part B Insider - 2014 Issue 4

Reader Question: Therapists Should Avoid Modifier 25

Question: Do you know if Medicare requires modifiers to be in a specific order? For example, on a 97002 that our physical therapist performed, we are adding GP and 25 and KX. We filed the modifiers in that order and Medicare denied for “benefit max.”   Answer: There are several issues here. Modifier GP refers specifically to a physical therapist and is used for the functional limitation G-codes. For re-evaluation services, PTs can report 97002 (Physical therapy re-evaluation). However, PTs can’t report modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or...

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