Are your bills being denied due to missing or improper modifiers? You are not alone!
In late 2019, UnitedHealthCare (Optum and UHC affiliates) required a particular modifier be appended to all physical medicine services. This modifier was also made a requirement for…
Welcome to your billing and coding weekly solutions by American Acupuncture Council Network (AAC).
Are your bills being denied due to missing or improper modifiers? You are not alone!
In late 2019, UnitedHealthCare (Optum and UHC affiliates) required a particular modifier be appended to all physical medicine services. This modifier was also made a requirement for Veterans Administration (VA) and Medicare claims.
Effective April 1, 2020, UnitedHealthCare updated the Procedure To Modifier Policy Professional to require the GN, GO, or GP modifier on ‘Always Therapy’ codes to align with the Centers for Medicare & Medicaid Services (CMS).
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 acupuncture claims, as it aligns with the therapy provider “physical therapy”.
Medicare does not pay acupuncture providers for therapy; however, GP is a necessary modifier to assure a proper denial for a secondary payer to make payment.
Remember, billing with incorrect acupuncture CPT and ICD codes can lead to claim rejections and delays in payments, which can have a devastating impact on generating revenue and keeping you in business.
If you are experiencing insurance claim denial, staff spending too much time trying to get claims paid, and patients asking why their claims have not been paid then American Acupuncture Council Network is your solution.
American Acupuncture Council Network stays ahead of the curve on the latest trends and changes in billing and coding by utilizing their direct channel of communication with the insurance companies and organizations that set the guidelines.
There is a reason acupuncturists have trusted AAC with their business for over 30 years.
4 Comments
yuriovi · August 2, 2021 at 9:49 am
On the form CMS-1500 02/12 in section 24 D we have modifier 25 for acupuncture service.Where we are suppose to put modifier GP from “Always Therapy”, in which section?
Yuru Ovchinnikov, L.Ac
The Blog Team · August 2, 2021 at 10:08 am
Modifiers are in section 24d and there are up to 4 spaces or sections for modifiers.
The EM code would have 25
Physical medicine codes would have GP
drlindasullivan · November 3, 2021 at 12:24 pm
Is there a different modifier than 59 for 97813/97814 and 97810/97811? Sometimes I get paid using 59 and other times it gets denied.
The Blog Team · January 21, 2022 at 9:01 am
59 is a modifier used for PT providers and chiropractors to distinguish separate services that may be similar. Such as a chiropractor distinguishing that a spinal adjustment was performed to a separate region of the spine from manual therapy 9714.
59 is not a modifier used or required for acupuncture coding and 97810-97814 should not have any modifier. If a claim is paid with it is likely the carrier is simply ignoring the modifier use it as it has no value there but some plans may deny it as it Is not appropriate for the code.