MedicaidPrior AuthHigh impact
Use modifiers with physical therapy (PT) and occupational therapy (OT) authorizations
Minnesota Medicaid (MHCP)·MN · Physical Therapy, Occupational Therapy·Prior Authorization
We identified it
May 5, 2026
Summary
Minnesota Health Care Programs (MHCP) now requires specific modifiers on all physical therapy (PT) and occupational therapy (OT) authorizations and claims: modifier GO for OT services, modifier GP for PT services (regardless of whether provided by therapist or assistant), and modifier U7 when an assistant provides services without the supervising therapist on site. Authorization requests and corresponding claims must match exactly, including modifiers, or claims will be denied. For members with third-party liability or Medicare, modifiers KX, CO, and CQ must also be used when appropriate.
Action Required
Immediately: Billing team must implement modifier requirements for all MHCP PT/OT claims and prior authorization requests. (1) Update billing software to automatically append modifier GO to all OT service codes and modifier GP to all PT service codes on both authorization requests and claims. (2) Configure system to append modifier U7 when assistant-provided services are identified without on-site supervising therapist. (3) For members with TPL or Medicare, ensure modifiers KX, CO, and CQ are applied per TPL/Medicare guidelines. (4) Establish verification process to confirm authorization request modifiers match claim modifiers before submission—claims with mismatched modifiers will be denied. (5) Train providers and front-desk staff to flag TPL/Medicare cases for modifier review. (6) If claim denial occurs due to modifier mismatch after authorization approval, contact Acentra medical review agent at 866-433-3658 for resolution. Failure to implement will result in systematic claim denials.