Modifier GO- Occupational Therapy Plan of Care

Modifier GO identifies services delivered under an outpatient occupational therapy plan of care.

Home > All Categories > Therapy Modifiers > Modifier GO

What is Modifier GO?

Modifier GO is used to identify services furnished under an outpatient occupational therapy plan of care.

Medicare uses GO to distinguish occupational therapy services from services furnished under physical therapy and speech-language pathology plans of care.

The modifier is reported with applicable CPT or HCPCS codes when the service is provided under an occupational therapy plan. It helps Medicare apply the appropriate outpatient therapy billing and payment requirements.

GO does not independently establish coverage or medical necessity. Documentation must support the patient's condition, skilled occupational therapy services, treatment goals, and applicable Medicare requirements.

When to Use Modifier GO

Occupational Therapy Plan: The service is furnished under an outpatient occupational therapy plan of care.

Applicable Therapy Service: The reported CPT or HCPCS code represents a service appropriately furnished under the OT plan.

Medicare Therapy Billing: GO is required under applicable Medicare outpatient therapy reporting requirements.

Skilled Occupational Therapy: The patient's condition requires the skills of an occupational therapy professional.

Treatment Matches Plan: The service is consistent with the goals and interventions established in the plan of care.

When NOT to Use Modifier GO

Physical Therapy Plan: Services furnished under a physical therapy plan generally require Modifier GP.

Speech-Language Pathology Plan: Services under an SLP plan generally require Modifier GN.

Service Is Outside the OT Plan: Do not use GO solely because an occupational therapist participated in the patient's care.

Unskilled Service: GO does not establish coverage for services that do not require skilled occupational therapy.

Documentation Is Insufficient: The medical record must support the underlying therapy service and applicable plan of care.

Billing Example

A Medicare beneficiary receives outpatient occupational therapy following an injury that limits the ability to perform daily activities.

The occupational therapist develops a plan of care addressing functional limitations involving dressing, grooming, and other activities of daily living.

An applicable therapy service is furnished according to the plan and reported with Modifier GO.

Documentation supports the patient's functional deficits, skilled intervention, treatment goals, and progress.

Documentation Requirements

Plan of Care: Maintain an established occupational therapy plan addressing the patient's functional needs.

Functional Limitations: Document the activities or abilities affected by the patient's condition.

Measurable Goals: Establish objective treatment goals related to improving or maintaining function.

Skilled Intervention: Document the occupational therapy techniques and services furnished.

Patient Progress: Record the patient's response to treatment and progress toward established goals.

Medical Necessity: Explain why skilled occupational therapy is required.

Certification Requirements: Maintain applicable physician or practitioner certification and recertification when required.

Billing and Claim Considerations

Modifier GO identifies that the service was furnished under an occupational therapy plan of care.

It should not be selected simply because an occupational therapist furnished the service. Medicare's therapy modifiers identify the plan of care associated with the service.

GO is part of a group of three commonly used Medicare outpatient therapy modifiers: GN for speech-language pathology, GO for occupational therapy, and GP for physical therapy.

Additional modifiers may be required depending on the circumstances. Modifier KX, for example, can apply when applicable Medicare therapy threshold requirements have been met and documentation supports continued medically necessary services.

Providers should verify that the procedure code, therapy modifier, documentation, plan of care, certification, and any additional modifiers accurately represent the service before submitting the claim.

Common Billing Mistakes

Using the Wrong Therapy Modifier: GO represents an occupational therapy plan, while GN and GP represent speech-language pathology and physical therapy plans.

Missing GO: An applicable occupational therapy service is submitted without the required therapy modifier.

Using GO Based Only on Provider Type: The modifier should reflect the applicable plan of care.

Missing Treatment Goals: Documentation does not contain measurable goals supporting skilled occupational therapy.

Insufficient Progress Documentation: The record does not adequately demonstrate the patient's response to treatment.

Missing Additional Modifier: Applicable circumstances may require another modifier in addition to GO.

Common Denial Reasons

GO Is Missing or Incorrect: The claim does not contain the appropriate therapy plan-of-care modifier.

Medical Necessity Is Unsupported: Documentation does not demonstrate why skilled occupational therapy is required.

Plan of Care Is Incomplete: Required treatment information or measurable goals are missing.

Certification Requirements Are Not Met: Applicable certification or recertification requirements have not been satisfied.

Procedure Code Is Unsupported: Documentation does not substantiate the service reported.

Coverage Requirements Are Not Met: The service does not satisfy applicable Medicare outpatient therapy requirements.

Modifier GO vs. GN and GP

Modifier GO: Services under an outpatient occupational therapy plan of care.

Modifier GN: Services under an outpatient speech-language pathology plan of care.

Modifier GP: Services under an outpatient physical therapy plan of care.

The correct modifier depends on the therapy plan of care associated with the service, not simply the procedure code or professional furnishing treatment.

Frequently Asked Questions

Does every Medicare occupational therapy service require Modifier GO?
Applicable outpatient therapy services furnished under an occupational therapy plan of care generally require the appropriate therapy modifier. Providers should verify current Medicare requirements for the specific service and setting.

Can Modifier GO and Modifier KX be reported together?
Yes. Both modifiers may be reported when each applies and the Medicare requirements associated with KX have been satisfied.