Medical Billing Forum

Billing => Billing => Topic started by: Anne on February 21, 2010, 09:57:47 PM

Title: 97530 for OT question
Post by: Anne on February 21, 2010, 09:57:47 PM
I just received a bunch of denials from Medicaid.  They are all for 97530 for occupational therapy, medicaid is secondary, saying "needs a modifier".  I DO use modifier GO for OT, GP for PT, and GN for ST.  But does anyone know if medicaid is now requiring ANOTHER modifier when using CPT code 97530?  This is TX medicaid, in case that makes a difference.  I have authorization for these patients and that code IS on each auth letter.
Title: Re: 97530 for OT question
Post by: Michele on February 22, 2010, 07:07:30 AM
I'm not familiar with TX Medicaid, but in NY there is no modifier required for the 97530.  The GP & GO are only for Medicare.  Have you tried calling and asking for an explanation?  I would start there.

Michele
Title: Re: 97530 for OT question
Post by: Anne on February 22, 2010, 09:28:58 AM
We also have to the use the GO, and GP modifiers for medicaid here.  No, haven't called yet.  I was working last night, Sunday night is when Status reports come in, and had so many denials, all requesting EOB's from primary, auth #'s and modifiers - all of which WERE on the claims, so thought maybe something new happened that I've missed somewhere. 
Calling now, already way behind this week and it's only 9:00 am on Monday! 
thanks.
Title: Re: 97530 for OT question
Post by: Pay_My_Claims on February 22, 2010, 11:14:24 AM
We also have to the use the GO, and GP modifiers for medicaid here.  No, haven't called yet.  I was working last night, Sunday night is when Status reports come in, and had so many denials, all requesting EOB's from primary, auth #'s and modifiers - all of which WERE on the claims, so thought maybe something new happened that I've missed somewhere. 
Calling now, already way behind this week and it's only 9:00 am on Monday! 
thanks.

good luck, and keep us posted as to what happened