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We received a denial for Orofacial Myofunctional Therapy from UnitedHealthcare for ‘procedure code is inconsistent with the modifier used’ ‘the service code was not submitted with an appropriate modifier’.
We billed CPT codes 97110 and 97112 together which we usually do. I have never used a modifier when submitting these 2 codes together but I realize coding guidelines change all of the time. Just reaching out to see if anyone has used a modifier when billing these codes together and if so what modifier to use. Also, do you report the modifier on the service lines for both codes or just for one or the other?
Thank you.
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Hi Guest!
Great question. the insurer may be looking for modifier 59:
Modifier 59 - Distinct Procedural Service (indicates that a procedure is separate and distinct from another procedure on the same date of service)
Or, we have seen some insurer require use of the GP, GO or GN modifier for:
97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility)
and
97112 (Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities)
These modifiers stand for:
GP - Services delivered under an outpatient physical therapy plan of care
GO - Services delivered under an outpatient occupational plan of care.
GN - Services delivered under an outpatient speech language pathology plan of care
Hope this helps!
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 1 user thanked courtneydsnow for this useful post.
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