Modifier Billing for Therapy Services
Date: 07/11/17
Managed Health Services (MHS) and Ambetter from MHS will be making an important change to our Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST) billing requirements.
Effective July 15, 2017, all claims billed with CPT and revenue codes for PT/OT/ST will require modifiers as outlined below:
- GN Services delivered under an outpatient speech-language pathology plan of care;
- GO Services delivered under an outpatient occupational therapy plan of care; or,
- GP Services delivered under an outpatient physical therapy plan of care.
The modifier will be required on all outpatient claims, including those billed with the following locations:
- 11 Office
- 12 Home
- 13 Assisted Living Facility
- 19 Off Campus Outpatient Hospital
- 22 Outpatient Hospital
- 31 Skilled Nursing Facility
- 32 Nursing Facility
- 62 Comprehensive Outpatient Rehab Facility
Claims billed without the appropriate modifier for date of service 7/15/2017 and forward will rejected with code 90: missing or invalid modifier.
We appreciate your attention to this important change. Thank you for being our partner in care.