Modifier GP is being adopted by additional carriers as a requirement for reimbursement of physical medicine services. This always therapy modifier is required by United Health and its affiliates since 2020. The modifier GP is also required for VA claims and Medicare (note Medicare does not pay for the therapies but is to receive a proper denial so a secondary payer may make payment).
However, as reported in our prior news posts more carriers are starting to require its use. Plans now that require its use include Blue Cross Blue Shield of Michigan, Blue Cross of California (For California providers this does not include Blue Shield of California), and now also by BCBS plans of Indiana, Kentucky, Missouri, New Jersey, New York (Empire) Ohio, Vermont, and Wisconsin.
Therefore all physical medicine codes 97010 through 97799 (PT codes) for these plans must be appended with a GP or will be denied as missing or incomplete modifier.
However, do not blanket all payers with GP for physical medicine services. If you get a denial indicating a missing modifier on a physical medicine code that may be the likely fix. The Network will continue to update our members as we become aware of additional payers who adopt.
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