Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation - Professional

In the contract amendment dated October 1, 2021, Anthem Blue Cross and Blue Shield in Virginia and our affiliate HealthKeepers, Inc. included updates to the following Commercial reimbursement policies:

 

• Modifier Rules – Professional

• Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation – Professional

 

For clarification, these modifier updates align with the codes the Centers for Medicare & Medicaid Services (CMS) has designated as “always therapy” services, and require GN, GO or GP modifiers for physical therapy, occupational therapy, or speech-language pathology services when billed on a professional claim.

 

1401-1121-PN-VA