Coding > Coding

Medicaid Modifiers for Chiropractic

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roseagain:
Is the modifier GP (outpatient Physical Therapy) allowed for chiropractic CPT codes 97530, 97110, 97112, 97140, and 97530? When I called Superior Health (a Texas Medicaid HMO) I was told that these codes needed either GO or GP. As GO is for occupational therapy, I didn't expect that would work. When I tried AT (the code that TMHP, the Texas Medicaid cite lists for chiropractic), my software (Kareo) said it was an invalid modifier for those CPT codes. I suppose I can submit the claim with AT anyway and see what Superior says, if in fact I am not allowed to use GP.

I just want to make sure I am not fraudulent by putting GP when the treatment was performed by a chiropractor and not a PT.

Thanks!

Michele:
The definition of the GP modifier :  GP    Services delivered under an outpatient physical therapy plan of care.

Doesn't state it must be a physical therapist, however, Medicare doesn't cover any codes for DC's except the 9894*  codes so I'm not sure why it would matter.  The AT is definitely valid on the 9894* codes as it is required (if appropriate) for payment.

Hope that helps.

roseagain:
Thanks Michelle, that is a big help!

I do remember what you mentioned about the 9894* codes and Medicare. Fortunately, this is a Medicaid HMO in Texas (Superior Health), so they accept a few more codes. I will go ahead and use the GP modifier.

Thanks again!

Tonya

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