Providers must be aware of Transmittal 2091 from Pub 100-04, Medicare Claims Processing which creates new edits in Medicare claims processing systems to ensure correct billing of therapy-related codes on institutional claims.

Modifiers are used to identify therapy services whether or not financial limitations are in effect. When limitations are in effect, the CWF tracks the financial limitation based on the presence of therapy modifiers. Providers /suppliers must continue to report one of these modifiers for any therapy code on the list of applicable therapy codes.

Contractors also edit to ensure that the therapy modifiers are present based on revenue codes 042X, 043X, or 044X. Claims containing revenue codes 042X, 043X, or 044X without a therapy modifier GN, GP, or GO are returned to the provider. Additionally, contractors ensure that revenue codes and modifiers are reported in the following combinations:

• Revenue code 42x (physical therapy) lines may only contain modifier GP

• Revenue code 43x (occupational therapy) lines may only contain modifier GO

• Revenue code 44x (speech-language pathology) lines may only contain modifier GN.