​​​As we prepare for the upcoming transition to our next generation platform, we want to remind you of billing guidelines to follow to ensure the proper processing of your claims.

Use of Modifiers

When billing with Modifiers, follow these billing guidelines that are in accordance with CMS.

• All therapy services furnished by physical, occupational, and speech therapists should be billed with the appropriate modifier.
  
  
• Additionally, CMS designates certain procedure codes as “Always Therapy." Claims containing codes defined as “Always Therapy" must be submitted with a therapy modifier.
  
  

​​​ ​GN	​​Services delivered under an outpatient speech-language pathology plan of care
GO	Services delivered under an outpatient occupational therapy plan of care
GP	Services delivered under an outpatient physical therapy plan of care

 

• Capped rental items should be billed with the appropriate secondary modifier. Therefore, if a DME claim is billed with an RR modifier, it should also contain the appropriate secondary modifier.
  
  

  ​​​​KH	First month rental
  KI	Second or third month rental
  KJ	PEN pump or capped rental forth – fifteen month rental ​

Report facility NPI with certain POS codes

When billing a professional claim with one of the facility place of service (POS) codes listed below, the facility NPI where the service was rendered must be reported in Box 32 when submitting the claim.

National POS value

 
When billing these codes, Box 32 on the CMS/HCFA 1500 form must contain the facility NPI where services were rendered.

We encourage you to frequently visit our dedicated Platform Transition page to stay up to date on the upcoming changes.