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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2011

Important new billing requirement for physical and occupational therapy services  

Effective for dates of service on or after September 1, 2011, all claims for physical or occupational therapy services must include HCPCS modifiers, regardless of the billing provider’s specialty. This requirement is in line with CMS billing policy, and is designed to ensure accurate claims processing and application of services to the appropriate member benefits.

Providers must report HCPCS modifier “GO” for occupational therapy services, and HCPCS modifier “GP” for physical therapy services. (CPT codes 97001–97546 and 97750–97799 comprise all physical and occupational therapy services affected by this requirement.) Claims submitted without the required modifiers will be denied (via denial code EX MM: “Modifier GO or GP missing; rebill w/mod to designate therapy service”) with provider liability.

For more information, see Harvard Pilgrim’s updated Physical, Occupational and Speech Therapy Payment Policy.

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