Modifiers Used in Physical Therapy Billing

Physical therapists and their staff use a variety of modifiers in billing for physical therapy services. Modifiers add clarity, accuracy, and specificity to physical therapy notes and help improve reimbursement from insurance companies. Modifiers are added to CPT codes and outline the specific physical therapy billing services provided. Here is an overview of the types of modifiers used in physical therapy billing: 

GP Modifier

This modifier is used when a physical therapist’s services have been provided in an inpatient or outpatient setting. This modifier should not be used if a physical therapist assistant has provided the service. The code helps medical offices to get paid for more procedures and promotes the proper documentation of services. Physical therapists commonly use GP modifiers when billing for physical therapy services. These services can include therapeutic exercises, manual therapy techniques, gait training, patient education, and counseling.

59 Modifier

A 59 modifier is an additional code that provides physical therapy billing services with information about a procedure or service. This helps determine what information should be included in future claims forms. This code can be added to other CPT codes when the service provided differs from the standard procedure for that particular code. A 59 modifier can also be used to report services that are not typically associated with each other.  

XE, XP, XS, and XU Modifiers

Modifiers XE, XP, XS, and XU can be more specific than 59. Practitioners are recommended to use them in place of 59 modifiers when possible. The XE modifier refers to treatment done at different times on the same day of service. XP modifiers help physical therapy billing professionals understand which services were performed by different physical therapists or practitioners. An XS modifier indicates a treatment or service that has been performed on another structure or part of the body than the original code specifies. XU modifiers inform billing professionals that the provided treatment is not usually performed alongside their other services or on the same treatment day.

KX Modifier

The KX modifier shows additional therapy costs that exceed the Medicare limit. This modifier is used when a patient has exceeded their insurance plan’s allotted amount for physical therapy services. KX modifiers are used to confirm that the services provided to the patient are necessary. These treatments are justified by appropriate documentation in the medical record. Physical therapy billing professionals use this modifier to get the proper reimbursement from insurance companies. 

GY Modifier

The GY modifier is used in physical therapy billing to indicate that a service is not covered by insurance providers. GY is often used when physical therapy physicians and practitioners want to indicate that the treatment does not meet the requirements to be covered by Medicare. Before using the GY modifier, physical therapy billing professionals must understand which services are excluded from coverage by Medicare and why they are excluded. This can help promote accurate billing, avoid potential compliance issues, and educate patients. 

Use the Proper Modifiers in Physical Therapy Billing Services

Modifiers are additional characters and codes used in physical therapy billing to provide more detail about the treatment procedure or service type. Using the proper modifiers in your physical therapy billing services can help your practice receive accurate payments from insurance providers. Use GY, KX, XE, XP, XS, XU, 59, and GP modifiers to clarify the conditions of your practice’s treatments and provide insurance companies with thorough information. The incorrect use of physical therapy billing modifiers can lead to denied claims and missing payments. Try to educate all staff members in your physical therapy practice about the appropriate billing modifier codes. This can lead to improved billing and claim submission processes within your practice.


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