Medicare Updates: Repetitive Billing for Pulmonary Rehab; Therapy Modifiers; Point of Origin Code Updates

on Wednesday, 17 November 2010. All News Items

Revenue code 0948, Pulmonary Rehabilitation services, has been added to the list of repetitive Part B services effective April 1, 2011. Institutional providers, such as hospitals, are required to bill repetitive services furnished to a single individual monthly or at the end of treatment. This updated information can be found in Transmittal 2092 or in MLN Matters Article MM7163.

CMS Transmittal 2091 explains requirements for the correct reporting of therapy modifiers (Modifiers GP, GO, and GN) on institutional claims. Only one modifier should be reported per line of service. Effective April 2011, Medicare is implementing new edits to return claims to the provider for correction if more than one of these modifiers is reported on the same line. Medicare also edits for the correct combination of modifier to revenue code as described below.

  • Physical Therapy, modifier GP, revenue code 042X
  • Occupational Therapy, modifier GO, revenue code 043X
  • Speech Language Pathology, modifier GN, revenue code 044X

For more information, see MLN Matters Article MM7170.

In accordance with updates by the National Uniform Billing Committee (NUBC), CMS is implementing the following changes effective April 1, 2011 concerning Point of Origin codes:

  • Point of Origin codes are no longer required on 14x bill types (used for non-patient laboratory specimens)
  • Point of Origin code 9 – information not available – will be accepted on all bill types.

This information can be viewed in MLN Matters Article MM7144.

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