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Therapy Services - Missing or Invalid Modifier

Date: 06/27/18

Allwell from Health Net and Ambetter from Health Net have noticed a significant increase in provider claims denying for missing or invalid modifiers.

Providers billing for Physical Therapy, Speech Therapy or Occupational Therapy services must bill services with the required modifier(s) as provided by The Centers for Medicare & Medicaid Services (CMS).

Providers receiving the following claim denial EXIM- Modifier missing or invalid should make the appropriate corrections and submit a corrected claim for adjudication. CMS reference details have been provided to prevent further denials.

Therapy Services- Missing or Invalid Modifier Denials (PDF)