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SNF Home Health Agency coding
Act
by Sep 30, 2026
Effective date
Oct 1, 2026
Identified
Oct 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 submitted with SNF/home health agency revenue codes 042X, 043X, or 044X. Claims missing the required modifier or containing an incorrect modifier will be denied.
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What to do
by Sep 30, 2026 · 4 steps
01Billing team must update billing software and claims processing systems to automatically append the correct therapy service modifiers (GP, GO, or GN) to CPT codes when submitted with revenue codes 042X, 043X, or 044X for SNF and home health agency claims.
02Audit all existing claim submission workflows and provider documentation templates to ensure therapy service type is captured at point of entry.
03Train billing staff and providers on the modifier requirements.
04After October 1, 2026, all claims submitted without the appropriate modifier or with an incorrect modifier will be denied by BCBSRI.
Original notice
SNF Home Health Agency coding
bcbsri.com · Always check the source before changing claims.