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Aetna to Implement Assistant Payment Reduction
Article Updated on October 26, 2023
Aetna has announced they will implement a payment reduction when outpatient therapy services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant. In this article, I will provide answers to the following questions:
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You mentioned Aetna will implement the physical therapist assistant and occupational therapy assistant payment reduction effective with dates of service on and after December 1, 2023. Will this impact PTA’s and OTA’s in Critical Access Hospitals?
I just added a new FAQ regarding critical access hospitals to this article regarding this question.
Do you know if the reduction will be implemented in all settings? We have both hospital based and critical access locations. Thank you!
I just added a new FAQ regarding critical access hospitals to this article regarding this question.
Aetna doesn’t currently recognize therapy discipline modifiers for Commercial products in a professional or facility setting. Have you seen anything that would indicate a change to this, in tandem with the assistant modifier requirement?
The therapy specific modifiers would not be a requirement in order to use CQ and CO modifiers. Whether or not Aetna will implement the therapy specific modifiers would be up to them, but would not be required for this new change.
WILL CRITICAL ACCESS HOSPITALS BE EXCLUDED LIKE THEY CURRENTLY ARE WITH CMS / MEDICARE?
I just added a new FAQ to this article regarding this question.
Thank you for the updated.
Hi Rick. Should we start using CQ modifiers now for Aetna even though the PTA payment differential doesn’t start until March 1 or should we wait until March 1 to use CQ?
My recommendation is to wait until it is implemented.