The 3 most common HCPCS modifiers used by physical therapy practices

1 minute, 39 seconds

The Healthcare Common Procedure Coding System (HCPCS) uses two primary types of codes: codes and modifiers. Each HCPCS code describes the services or procedures performed while modifiers are added to codes to provide supplemental information. These modifiers can signify important information to insurance companies, hospitals, other medical providers and patients themselves. 

In this article, we’re going to focus on some HCPCS modifiers that are important for physical therapists to know. These modifiers will help you to create the most accurate possible billing documentation. 

Important HCPCS modifiers for physical therapists

Here are some of the most commonly used modifiers in the PT world:

  1. GP — This modifier is used in health care institutions where multiple types of medical professionals work, such as hospitals. It signifies which type of professional provided the services rendered where there might otherwise be confusion. For instance, a physical therapist might use this if the serve could have been performed by a physician. As the PT who performed the service, this ensures that you will be reimbursed properly.
  2. GX — This modifier is used when patients wish to continue receiving physical therapy services even after they have restored functionality. Because maintenance therapy is not typically covered by insurers, the GX modifier enables you to bill secondary insurers or the patient themselves. When using this modifier, it’s important to communicate with the patient to ensure they understand that they will have to pay for the services themselves if they lack secondary insurance or their secondary insurer denies coverage.
  3. KX — This HCPCS modifier is used when a patient with Medicare insurance exceeds Medicare’s threshold for therapy services. The threshold changes from year to year, but this modifier indicates that you’ve deemed continued treatment to be medically necessary.

Alliance PTP can help you streamline your documentation process

Partnering with us gives you access to our proprietary EMR software, which features a built-in rules engine that automatically updates your documentation with the correct modifiers. You also get access to our network of experts who can manage your billing process and train your staff on documentation best practices.

Contact our team today for more information about how we can help your practice or to find out how you can join our partnership in care.