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
Sep 1, 2026
Summary
Effective October 1, 2026, BCBSRI will enforce a coding edit requiring therapy service modifiers (GP for physical therapy, GO for occupational therapy, GN for speech-language pathology) to be appended to CPT codes when billing with SNF/HHA therapy revenue codes 042X, 043X, or 044X. Claims missing the required modifier or containing an incorrect modifier will be denied.
Action Required
By September 30, 2026: Billing team must update billing system to automatically append or require the appropriate therapy modifier (GP, GO, or GN) to all CPT codes submitted with revenue codes 042X, 043X, or 044X for BCBSRI claims. Audit all SNF and HHA therapy claims currently in workflow to identify and correct any missing or incorrect modifiers before the effective date. Train providers and clinical staff to ensure proper modifier assignment at point of service. Update claim submission templates and verification processes to validate modifier-to-service alignment. Failure to include the correct modifier will result in claim denials on or after October 1, 2026. Contact ProviderRelations@bcbsri.org with implementation questions.