Fulcrum requires HCPCS modifiers GP, GN, or GO to be reported with codes designated by CMS as “always therapy” for Medicare lines of business. These services must be furnished under a physical therapy, occupational therapy, or speech-language pathology plan of care as they are always considered therapy, regardless of who performs the service.

Service providers must be qualified and recognized by Medicare to perform these services. Appending the modifier does not allow for services to be rendered outside of the provider’s scope of practice. Application of the appropriate modifier does not guarantee payment of the service and correct coding guidelines should be followed.

Fulcrum’s payer partners (PPOs, HMOs, Employer Coalitions and other health plans) may apply this requirement to commercial plans.

For Quartz, effective 07/15/24, HCPCS Modifiers GP, GN, or GO will apply to commercial plans.

If you have any questions, please contact Fulcrum Provider Services at providerservices@fulcrumhealthinc.org or (877) 886-4941.

We welcome our expanded partnership with Prime Health for in-network chiropractic, acupuncture, massage, physical, occupational and speech therapy services!  

Prime Health is a national Preferred Provider Organization (PPO) that offers services in all 50 states. Prime Health’s PPO network is utilized by commercial group health, workers’ compensation, and auto medical liability clients.

To view the most up-to-date resources including the updated Fee Schedules and Plan Summary Reference Sheet, on Fulcrum's Provider Portal, follow these steps:

1.    Scroll through Your Health Plans on the home page of portal

2.    Find and expand Prime Health Plan

3.    Open and review the Plan Summary Reference for Prime Health and Fee Schedules, which may be state specific, to identify the products.



Claims for this program are not submitted to Fulcrum. Claims should be submitted to the applicable payor, as listed on the plan summary reference sheet.

If you have any questions, please contact Fulcrum Provider Services at providerservices@fulcrumhealthinc.org or (877) 886-4941.

The federal No Surprises Act (H.R. 133, P.L. 116-260) requires providers and health plans to verify the accuracy of provider contact information every 90 days.

Complete the following steps every 90 days to attest, which fulfills the No Surprises Act requirement: 

Step 1: 

View/Update Demographic Information on Fulcrum's Provider Portal.

• Click on the location that you would like to view/update.
• Enter your updated information along with the effective date and then click the Submit button for your changes to be saved.

Step 2:

Attest

• Click on the NSA Attestation button and check the checkbox after reading the attestation and click Submit button.



If you need to add a location, or are moving locations, please review the instructions on the Demographic Updates tab on the portal for how to complete.