We’ve heard from several of you regarding recent denials from Regence Blue Cross Blue Shield (BCBS) related to supportive therapy codes — specifically 97140, 97110, 97112, and 97530 — when billed with the -59 modifier.
After multiple attempts to gain clarity from BCBS and Availity (their portal support), we received minimal direction beyond being advised to “review CMS guidelines and monthly newsletters.” Unfortunately, this has led to continued confusion for many Utah chiropractors.
Here’s what we’ve learned and want to share:
What’s Going On:
BCBS appears to have made a system-wide update, applying edits that now automatically deny “Always Therapy” codes unless specific conditions are met.
The Key Modifier: -GP
Several doctors have found success by adding the -GP modifier to these CPT codes. Why?
- BCBS considers these codes under Physical Therapy (PT) benefits.
- In line with CMS guidelines, “Always Therapy” codes typically require the -GP modifier to indicate services were provided under a therapy plan.
- The -GP modifier suggests the therapies are part of a structured, medically necessary outpatient therapy plan, not just routine additions.
Claims using -GP in place of -59 are reportedly being paid.
What This Means for You:
- Consider updating your coding for 97140, 97110, 97112, and 97530 to include the -GP modifier.
- Make sure your documentation supports a clear plan of care aligned with outpatient therapy guidelines.
- Keep an eye on additional denials and let us know what you’re experiencing — the more data we gather, the stronger our advocacy can be.
We understand how frustrating these coding changes and denials can be, especially when clear guidance is lacking. The UCPA is actively monitoring this issue and working with our contacts to gain further clarification and consistency across payers.
If you have additional experiences or questions, feel free to email us at ucpaed@gmail.com.
We’ll keep fighting for clear, fair, and supportive policies that allow you to care for your patients without unnecessary administrative hurdles.