CQ/CO Therapy Assistant Modifiers for Medicare in 2022

The Centers for Medicare and Medicaid Services (CMS) initiated the CQ/CO modifiers with dates of service on and after January 1, 2020. However, beginning with dates of service on and after January 1, 2022, CPT codes that contain the CQ/CO modifier on them on the claim form will have their payment reduced. In this article, I will answer the following questions:

1. What is the description of each of the therapy assistant modifiers?
2. What outpatient therapy settings will the new modifiers be required to be used when applicable?
3. Do the PTA and OTA modifiers apply to critical access hospitals?
4. Are the new PTA and OTA modifiers required for inpatient therapy services?
5. Are the new PTA and OTA modifiers replacing the discipline specific therapy modifiers of GO and GP?
6. Is there a specific order of the modifiers on the claim form?
7. Will the new modifiers apply to Medicare Advantage plans as well as state Medicaid and Medicaid Advantage plans?
8. How is CMS defining in whole or in part?
9. Based on the answer to Question #8, can you give some examples when the CQ/CO modifier would and would not be required to be appended to a CPT code on the claim form?
10. Did CMS implement any new documentation requirements that must be in the medical record to support why you did or did not append the modifier to a CPT code on the claim form?
11. Will the 2 new modifiers, when appended to the CPT code(s) on the claim form, reduce payment of that CPT code to the provider?
12. How will CMS calculate the 15% reduction?
13. Besides traditional Medicare, have any other insurance carriers implemented the CQ/CO modifiers?

Let’s Begin!

Question #1
What is the description of each of the therapy assistant modifiers?

Answer #1

Question #2
What outpatient therapy settings will the new modifiers be required to be used when applicable?

Answer #2

Question #3
Do the PTA and OTA modifiers apply to critical access hospitals?

Answer #3

Question #4
Are the new PTA and OTA modifiers required for inpatient therapy services?

Answer #4

Question #5
Are the new PTA and OTA modifiers replacing the discipline specific therapy modifiers of GO and GP?

Answer #5

Question #6
Is there a specific order of the modifiers on the claim form?

Answer #6

Question #7
Will the new modifiers apply to Medicare Advantage plans as well as state Medicaid and Medicaid Advantage plans?

Answer #7

Question #8
How is CMS defining in whole or in part?

Answer #8

Question #9
Based on the answer to Question #8, can you give some examples when the CQ/CO modifier would and would not be required to be appended to a CPT code on the claim form?

Answer #9

Question #10
Did CMS implement any new documentation requirements that must be in the medical record to support why you did or did not append the modifier to a CPT code on the claim form?

Answer #10

Question #11
Will the 2 new modifiers, when appended to the CPT code(s) on the claim form, reduce payment of that CPT code to the provider?

Answer #11

Question #12
How will CMS calculate the 15% reduction?

Answer #12

Question #13
Besides traditional Medicare, have any other insurance carriers implemented the CQ/CO modifiers?

Answer

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