Therapy Modifier Consistency Edits

The Centers for Medicare and Medicaid Services (CMS) has released an article in which CMS creates edits in original Medicare claims processing systems to ensure that certain ‘always therapy’ evaluation and reevaluation codes are reported with the correct modifier. It also makes several clarifications of details in the “Medicare Claims Processing Manual,” Chapter 5 – Part B Outpatient Rehabilitation and Comprehensive Outpatient Rehabilitation Facility (CORF) Services.

In the past, occupational therapy evaluation and re-evaluation CPT codes have been reimbursed even though they contained the GP discipline modifier instead of the GO discipline modifier. The same has also occurred when the physical therapy evaluation or re-evaluation CPT codes were billed with the GO discipline specific modifier instead of the GP discipline specific modifier, those services were still reimbursed. The new edits created by CMS will no longer reimburse the PT and OT evaluation and re-evaluation CPT codes when they are not submitted with the correct discipline specific modifier appended to them on the claim form.

The article also provides instructions how to rebill Part B therapy services when an inpatient stay is denied as not reasonable and necessary. To read the article, click