GP Modifier (2022) Description, Uses, Guidelines & Examples

GP Modifier appends for the services when the physician delivers under an outpatient physical therapy care plan. In this article, we discuss the definition of Modifier GP and when it is appropriate to use it in medical coding.

GP Modifier Description

GP Modifier attaches to the service when the physician or physical therapist provides the service to the patient in an outpatient setting. 

CMS requires a modifier GP when the physician provides the physical therapy service to the patient for reimbursement. The following are the types of physical therapies that may need GP needs on the claim:

Modifier GP appends to Orthopedic physical therapy that aids in treating injuries on muscle, bones, tendons, fascia, and ligaments. These conditions are payable when the patient suffers from different conditions such as sprains, fractures, tendinitis, bursitis, rehabilitation, or recovery from orthopedic surgery and other choric health issues.

They may treat through manual therapy, mobility training, strength training, joint mobilizations, and different mobilities. 

GP Modifier appends to Geriatric physical therapy that deals with older adults suffering from various physical conditions such as Alzheimer’s disease, arthritis, urinary incontinence, balance issues, and hip joint replacement. It may help regain mobility, enhance physical fitness, and lower joint pains.

Modifier GP appends to Neurological physical therapy that plays a vital role in neurological conditions such as cerebral palsy patient, Parkinson’s disease, deadly brain injury, multiple sclerosis, spinal cord injury, and stroke. It may aid in improving muscle strength and limb responsiveness and promote balance.

GP Modifier appends to Cardiovascular and pulmonary rehabilitation, which is critical in dealing with patients with cardiopulmonary conditions and surgical procedures. It may be helpful in the treatment of cardiovascular strength and stamina.

Modifier GP appends to Wound care therapy, Decongestive therapy, Vestibular therapy, and Pelvic floor rehabilitation. These therapies may aid wound healing and inner ear conditions and improve blood circulation by utilizing compression therapy, electrical stimulation, and wound care. 

Decongestive therapy can help drain accumulated fluid in patients with lymphedema and other fluid accumulation conditions. It may help treat the pelvic floor problems such as urinary urgency, incontinence, pelvic pain, etc., which can arise from surgeries or other injuries. 

CMS requires modifiers for these services when physical therapists bill these services to achieve compliance. Modifier GP may need with all claim lines for Physical therapy patients when submitting to Medicare.

In contrast, Modifier GO and GN are used by a speech-language pathologist or under an outpatient speech-language pathology plan of care and an occupational therapist or an outpatient occupational therapy plan.

Modifier GP is only applicable with the service when service performs by the therapist, and It is inappropriate to report modifier GP with a non-therapist. 

What Is GP Modifier?

GP Modifier represents the services provided to the patient by a physical therapist. These services are frequently billed in inpatient and outpatient multidisciplinary settings. 

For Instance, To ensure the insurance that the physician or provider delivers the physical therapy service in an interdisciplinary therapy setting. The physical therapist must report severity modifiers, G codes, and therapy modifiers as functional limitation reporting (FLR).

Some insurance or third-party payers may require therapy billing modifiers to specific CPT codes instead all therapy codes.

When To Use GP Modifier

Corresponding to CMS (Centers for Medicare and Medicaid Services) guidelines, Modifier GP appropriates when the physician or physical therapist provides the service under an outpatient physical therapy care plan. 

The physician provides physical therapists service, or the item is part of the established care plan for physical therapy. 

Modifier GP applies when the physician or physical therapist provides the service in an outpatient setting. The patient’s condition or diagnosis may not require to admit to the hospital. A plan of care must require by Medicare for reimbursement of physical therapy. 

GP Modifier Guidelines

Documentation must support the medical necessity of the service and be medically appropriate according to the patient’s condition.

GP Modifier is inappropriate to append with the services when the CPT codes are not applicable under the list of therapy services or may not represent the type of therapy service provided to the patient. 

The contractor may require the following revenue code 042x to ensure validity when a modifier GP is attached to the institutional claim. The other revenue codes, such as GO and GN, may require 043x, which represents the occupational therapy service, and 044x may need for speech-language pathology.

Modifier GP is inapplicable to report on the same claim line with modifiers GN and GO. Billing occupational therapy and speech-language pathology on the same claim line as physical therapy is inappropriate. All these must report separately. 

GP Modifier is appropriate to report with modifier CQ when the assistant physical therapist performs the service n whole or in part by physical therapist assistants (PTAs). Modifier CQ is effective for services provided on January 2020 and after this service date. 

GP Modifier Examples

The following are examples of when GP Modifier appends with the services:

Example 1

A 35-year-old male came to the therapist in an outpatient hospital setting for a traumatic shoulder injury two weeks ago. A patient has 10/10 pain severity, and it was unbearable. 

The physician sends the patient to the therapist for electrical stimulation of pain. The therapist attached all the modules and electrodes and set all the parameters to the targeted site.

 The rest of the simulation was done by the patient under the physician’s supervision without involvement after getting 30-minute sessions comprised of two intervals. 

The patient feels reduced pain and is better than earlier. Now patient pain severity is 2 out of 10, and feeling much better. The therapist scheduled three more sessions this week for electrical stimulation of pain.

The patient has Medicare insurance and getting better through PT sessions. Modifier GP attached with CPT code for treating a traumatic shoulder injury.

Example 2

A 56-year-old male presents to a therapist in an outpatient hospital for inflamed hip, ankle, and joints. The patient had acute pain in the lower extremity joints. 

The patient denies headache, nausea, vomiting, or nervous system abnormality. The pain was not healing from any medications and treatments. The therapist decided to do an electrical stimulation of these joints. He placed all the electrodes on the targeted part and set the module parameters.

Therapies are in four intervals of 20 minutes. The patient does the rest part and massages all the lower extremity joints. After a 15 to 20 minutes session, the patient felt better and more pain deficient.

The assistant of a physical therapist performed the other 20 minutes. The physician rescheduled electrical stimulation for the next 3 to 4 days of pain management.

The physical therapist performs this service for Medicare patients to heel the inflamed joints. If the assistant serves during the PT of lower extremity joints, the CQ modifier attaches to the CPT code with GP. It is appropriate to report with modifier GP.

Example 3 

A 36-year-old male had surgery on knee joints two weeks ago and presents to the therapist in an outpatient hospital setting. He got muscle dystrophy and poor movement. The patient also had muscle contraction issues and knee pain. 

The therapist decided that electrical stimulation improves the blood flow in the knee joint. The therapist placed to set the parameters of the device and wires to the targeted knee joint. 

The PT performs four sessions of 15 minutes to massage with medications. The physician was present to supervise the whole session while the patient was doing the massage alone. Patients feel good after the session, and reduce pain from severe to mild. The therapist scheduled four more sessions to complete the heel pain.

The patient’s knees are getting better with each PT session, and The service is appropriate to report to GP for the treatment of muscular dystrophy. 

CPT 97140 Modifier GP

The physician sees the patient with back pain and needs therapy. The first fifteen minutes of treatment provides by the clinic PTA (Physical therapist assistant and the following 23 minutes provides by the PT (Physical therapist). They provide physical exercise treatment for low back pain.

These services offer to the patient by a PT (Physical therapist) and PTA (Physical therapist assistant. The service provided by the Physical therapist, occupational therapist, or SLP requires modifiers such as GP, GN, and GO. In the current scenario, PTA service bills with two units of CPT 97110 with CQ modifier and 97140 with GP Modifier for PT services. 

• 97140: GP
• 97110 (1 unit): GP
• 97110 (1 unit): GP, CQ

Modifier GP and GO

Modifier GO appends for the services when the physician delivers under an outpatient occupational therapy care plan. In contrast, GP Modifier is appropriate to report for physical therapy services.