CommercialBilling CodesHigh impact
SNF HHA PT Coding
Blue Cross Blue Shield of Rhode Island·RI · Physical Therapy, Occupational Therapy, Speech Therapy·Physician / Facility
Effective date
Oct 1, 2026
We identified it
Aug 1, 2026
Summary
BCBSRI is implementing a claims processing edit effective October 1, 2026, requiring that all therapy service claims submitted with revenue codes 042X, 043X, or 044X must include the appropriate therapy modifier (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) appended to the CPT code. Claims missing the required modifier or with an incorrect modifier will be denied.
Action Required
By September 30, 2026: Billing team must update billing software to automatically append the correct therapy service modifiers (GP, GO, or GN) to all CPT codes submitted with revenue codes 042X, 043X, or 044X for SNF and HHA claims. Coordinate with providers and clinical staff to ensure therapy service designations are accurately documented in the EMR before claim submission. Implement a verification process to confirm correct modifier pairing before claims are transmitted to BCBSRI. Failure to append the required modifiers will result in claim denials effective October 1, 2026. Contact ProviderRelations@bcbsri.org with implementation questions.