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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Therapy Modifiers

Modifiers That Are Always Required

GN: Speech Therapy

GO: Occupational Therapy

GP: Physical Therapy

KX Modifier

Append the KX modifier to all claims above the 2023 KX threshold:

PT + SLP Combined = $2230 

OT = $2230

See the KX Modifier page for more details.

Therapy Assistant Modifiers

CO: Outpatient occupational therapy services furnished in whole or in part by an OTA.

CQ: Outpatient physical therapy services furnished in whole or in part by a PTA.

See our CO/CQ guides for more information.

NCCI Modifiers

Modifier 59: “Distinct Procedural Service", it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.

XE : “Separate Encounter", a service that is distinct because it occurred during a separate encounter. Only use XE to describe separate encounters on the same date of service.

XS: “Separate Structure", a service that is distinct because it was performed on a separate organ/ structure.

XP: “Separate Practitioner", a service that is distinct because it was performed by a different practitioner.

XU: “Unusual Non-Overlapping Service", the use of a service that is distinct because it does not overlap usual components of the main service.

See our NCCI Page for more information.


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