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MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)
Effective date
Jan 15, 2024
Identified
Sep 19, 2026
Summary
Independence Blue Cross reissued MA10.003j with retroactive effective date of 01/15/2024, adding low-level laser therapy (LLLT/Photobiomodulation) as experimental/investigational and not covered, adding CPT code 97037 to the experimental section, and requiring mandatory modifiers GO (Occupational Therapy) and GP (Physical Therapy) for all PT/OT billing.
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What to do
Action · 8 steps
01IMMEDIATELY (retroactive to 01/15/2024): Billing team must implement the following changes to all Independence Blue Cross Medicare Advantage claims.
02Append modifier GO to all occupational therapy service codes and modifier GP to all physical therapy service codes in billing system.
03Deny or reject any claims for CPT 97037 and low-level laser therapy (LLLT/Photobiomodulation) services as experimental/investigational—flag claims for patient notification.
04Audit all PT/OT claims submitted since 01/15/2024 lacking required modifiers and resubmit with corrections.
05Update billing software rules and encounter forms to automatically apply modifiers GO and GP.
06Train all billing staff on modifier application requirements.
07Failure to apply required modifiers will result in claim denials.
08Non-compliance with LLLT coverage denial will result in improper reimbursement.
Codes mentioned
97037GOGP95992970129701497016970189702297024970289703297033G0281G0283L74.510L74.511L74.512L74.513L74.519H81.10H81.11H81.12H81.13
Original notice
MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)MediumEffective Jan 15, 2024 · Medical Policy10.03.01o, Outpatient Physical Medicine, Rehabilitation, and Habilitation ServicesMediumEffective Jan 15, 2024 · Medical Policy10.03.01o, Outpatient Physical Medicine, Rehabilitation, and Habilitation ServicesLowNo effective date · Medical PolicyMA05.066d, Cranial Electrotherapy StimulationMediumEffective Jan 2, 2024 · Medical PolicyBrowse every Independence Blue Cross change in the policy list
Related policy hubs
Independence Blue Cross policiesPhysical TherapyOccupational TherapyPM&R (Physical Medicine & Rehab)Sports MedicineCode 97037Code GOCode GPCode 95992Code 97012Code 97014Code 97016Code 97018Code 97022Code 97024Code 97028Code 97032Code 97033Code G0281Code G0283Code L74.510Code L74.511Code L74.512Code L74.513Code L74.519Code H81.10Code H81.11Code H81.12Code H81.13