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March 2020

Physical, occupational and speech therapy outpatient professional claims to require appropriate modifier

Effective May 1, 2020, physical, occupational and speech therapy providers must append the appropriate modifier to procedure codes for all outpatient professional claims for physical, occupational and speech therapy services. Therapy providers are encouraged to begin billing with the modifiers as soon as possible.

The Blue Cross Blue Shield of Michigan claims processing system is being updated to reject all outpatient professional claims for therapy services that are submitted without a modifier as follows:

  • Speech-language therapy — bill with the GN modifier
  • Occupational therapy — bill with the GO modifier
  • Physical therapy — bill with the GP modifier

We notified providers about this new requirement in an October 2019 Record article and followed up with a web-DENIS message in January. Outpatient professional claims billed without a therapy modifier will be rejected as provider liable.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2019 American Medical Association. All rights reserved.