On July 27, 2017, CMS issued a Change Request (CR 10176) which impacts claims processing of “Always Therapy” service codes. This change request became effective 1/1/2018 and this PTS Alert is intended to insure our valued partners are prepared to comply with the claims processing requirements for “Always Therapy” services.
CR 10176 implements revised editing of Part B “Always Therapy” services to require a therapy modifier in order for the service to be accurately applied to the therapy cap. While this is not a change or enactment of a new policy, the guidelines presented in CR 10176 will improve enforcement of existing instructions which could result in the return/rejection of claims if appropriate therapy modifiers are not included.
What You Need To Know
Providers should expect the following:
• MAC’s will return/reject claims which contain an “always therapy” procedure code, but do not also contain the appropriate discipline-specific therapy modifier of GN (Speech Therapy), GO (Occupational Therapy), or GP (Physical Therapy).
• MAC’s will return/reject claims if any service line on the claim contains more than one occurrence of a GN, GO, or GP therapy modifier.
• MAC’s who are returning/rejecting such claims will use Group Code CO and Claim Adjustment Reason Code (CARC) 4 on the related remittance advice.