Therapy Modifier Notice
Dear Providers,
Many payors, including Medicaid, are requiring the use of a therapy modifier to identify when a therapy service is furnished under an SLP, OT, or PT plan of care, respectively.
To be consistent, MPC will now require the use of one of these three therapy modifiers (GN, GO, or GP) for the following (HCPCS):
| SLP Codes | ||
| Code | Description | Modifier |
| 92521 | Evaluation of speech fluency | GN |
| 92522 | Evaluate speech production | GN |
| 92523 | Speech sound lang. comprehend | GN |
| 92524 | Behavioral quality analysis voice | GN |
| 92597 | Oral speech device eval. | GN |
| 92607 | Ex for speech device Rx 1hr | GN |
| OT Codes | ||
| Code | Description | Modifier |
| 97165 | OT eval low complex 30 min | GO |
| 97166 | OT eval mod complex 45 min | GO |
| 97167 | OT eval high complex 60 min | GO |
| 97168 | OT re-eval est. plan care | GO |
| PT Codes | ||
| Code | Description | Modifier |
| 97161 | PT eval low complex 20 min | GP |
| 97162 | PT eval mod complex 30 min | GP |
| 97163 | PT eval high complex 45 min | GP |
| 97164 | PT re-eval est plan care | GP |
The following HCPCS codes will also require the modifiers as appropriate:
| 92507 | 92508 | 92526 | 92608 | 92609 | 96125 | 97012 | 97016 |
| 97018 | 97022 | 97024 | 97026 | 97028 | 97032 | 97033 | 97034 |
| 97035 | 97036 | 97039 | 97110 | 97112 | 97113 | 97116 | 97124 |
| 97139 | 97140 | 97150 | 97530 | 97533 | 97535 | 97537 | 97542 |
| 97750 | 97755 | 97760 | 97761 | 97762 | 97799 | G0281 | G0283 |
| – | – | – | – | – | – | – | G0329 |
If you have any questions, please call your Provider Services department toll-free at 1-800-953-8854.
