What Is GP Modifier?

Are you curious to know what is gp modifier? You have come to the right place as I am going to tell you everything about gp modifier in a very simple explanation. Without further discussion let’s begin to know what is gp modifier?

In the complex world of healthcare billing and coding, various modifiers play a crucial role in ensuring accurate reimbursement and claims processing. One such modifier is the GP modifier. In this blog, we will delve into the GP modifier, what it represents, and its significance in the healthcare industry.

What Is GP Modifier?

The GP modifier is a two-character code used in medical billing and coding to indicate that a service provided was performed by a physical therapist (PT) in a private practice. It is essential in accurately documenting and billing for the services delivered by physical therapists and ensuring that they receive proper reimbursement for their work.

Key Information About The GP Modifier

  1. Representation: The GP modifier is represented by two characters: “GP.”
  2. Physical Therapy Services: The GP modifier is primarily used to identify services provided by licensed physical therapists in a private practice setting.
  3. Private Practice vs. Facility: It is essential to distinguish between services provided in a private practice and those offered in a facility (such as a hospital or skilled nursing facility). The GP modifier helps differentiate these settings.
  4. Required Documentation: Proper documentation and coding are necessary to accompany the GP modifier to ensure that the service accurately reflects the work performed by a physical therapist.

Significance Of The GP Modifier

The GP modifier holds significant importance in the healthcare industry for the following reasons:

  1. Accurate Reimbursement: The GP modifier ensures that physical therapists in private practice receive the appropriate reimbursement for the services they provide. This distinction is crucial to avoid underbilling or overbilling.
  2. Medicare Billing: The GP modifier is especially relevant when billing Medicare for physical therapy services in a private practice. It helps Medicare identify the provider type and setting accurately.
  3. Compliance: Proper use of modifiers, such as the GP modifier, is essential for compliance with healthcare billing and coding regulations and standards. It helps maintain transparency and accuracy in the billing process.
  4. Documentation Clarity: The GP modifier clarifies the type of service provider and the setting in which the service was rendered. This ensures that both the payer and the patient have a clear understanding of the billed services.

When To Use The GP Modifier?

The GP modifier is used when billing for physical therapy services provided by licensed physical therapists in private practice settings. These services can include, but are not limited to, the following:

  • Evaluation and assessment of the patient’s condition.
  • Development and implementation of a physical therapy plan of care.
  • Therapeutic exercises and interventions aimed at improving a patient’s physical function, mobility, and well-being.

It is crucial to consult the current billing and coding guidelines and regulations, as they may evolve over time. Accurate usage of the GP modifier is essential for appropriate billing and claims processing.

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The GP modifier serves a vital role in the healthcare industry, ensuring that physical therapists in private practice receive accurate reimbursement for their services. It helps maintain billing and coding accuracy, distinguishes between practice settings, and promotes compliance with healthcare regulations. Healthcare professionals and billing specialists must be well-versed in the correct usage of modifiers like GP to ensure the transparency and integrity of healthcare billing processes.


What Is GP Modifier Used For?

The GP modifier indicates that a physical therapist’s services have been provided. It’s commonly used in inpatient and outpatient multidisciplinary settings. It’s also used for functional limitation reporting (FLR), as physical therapists must report G-codes, severity modifiers, and therapy modifiers.

Can A Chiropractor Use Modifier GP?

UHC Claims Will Require GP Modifier For Therapy Codes

So if you render and bill for 1-2 regions of CMT (98940) and therapeutic exercise (97110), then the 97110 chiropractic CPT code will receive the GP modifier.

What Is The Difference Between GP And 97 Modifier?

The -97 modifier is used when the physical therapy services are rehabilitative in nature. The CO, CQ, GO, GP modifiers are all modifiers that indicate who performed the service.

Does A Cpt Code For 97110 Need A GP Modifier?

Modifiers GP(Outpatient Physical Therapy), GO (Outpatient Occupational Therapy), GN (Outpatient Speech-Language Pathology), CO (Outpatient Occupational Therapy by an Occupational Therapy Assistant (completely or partially)), CQ (Outpatient Physical Therapy by a Physical Therapist Assistant (completely or partially)), …

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