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Independence Blue CrossMedicare Advantage · Billing Codes · Medical Policy · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +2 moreMedium impact

MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)

Effective date
Jan 15, 2024
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued MA10.003j (effective 01/15/2024, posted 06/03/2024) with no substantive changes to coverage criteria. The policy clarifies that Low-Level Laser Therapy (LLLT/Photobiomodulation) is experimental/investigational and not covered, adds CPT code 97037 to the experimental section, and mandates two new billing modifiers: GO for Occupational Therapy and GP for Physical Therapy services to ensure accurate service reporting.

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What to do

Action · 7 steps
01By 01/15/2024 (retroactive): Billing team must update billing software and claim submission processes to.
02Append modifier GO to all occupational therapy service claims and modifier GP to all physical therapy service claims.
03Deny or reject claims for CPT 97037 and any low-level laser therapy/photobiomodulation services as experimental/investigational and not covered.
04Update denial templates to reference experimental/investigational status.
05Verify that PT/OT claims submitted without the required modifiers are corrected and resubmitted.
06Train billing staff and providers on mandatory modifier usage.
07Note: Policy was reissued on 06/03/2024 with retroactive 01/15/2024 effective date, so claims may require retroactive adjustments if already submitted without modifiers.

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.
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Related changes

See all Independence Blue Cross changes →
MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)HighEffective 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 MedicineOrthopedicsCode 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

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