Do The PTA/OTA Modifiers Apply to Critical Access Hospitals

February 25, 2021
Rick Gawenda

Due to the Bipartisan Budget Act of 2018, the Centers for Medicare and Medicaid Services (CMS) implemented the CQ and CO modifiers to be appended to CPT codes on the claim form when those services are provided in whole or in part by a physical therapist assistant (PTA) and occupational therapy assistant (OTA), respectively. This requirements began in calendar year 2020 and for calendar years 2020 and 2021, the application of these modifiers to CPT codes on the claim form have no financial implication on the payment for outpatient therapy services.

Beginning for dates of service on and after January 1, 2022, CPT codes submitted to the Medicare Administrative Contractor (MAC) that has either the CQ or CO modifier appended to it will be reimbursed at 85% of what a physical therapist or an occupational therapist would be paid for providing the exact same services under the Medicare Physician Fee Schedule (MPFS).

So lets answer the question “Do the PTA and OTA modifiers apply to critical access hospitals?”


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For additional questions and answers on the CQ and CO modifiers, check out my PTA and OTA FAQs.

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