Question

    I hear that the Centers for Medicare and Medicaid Services (CMS) is implementing 2 new modifiers that will have to be appended to CPT codes on the claim form when that service is provided in whole or in part by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). What are the 2 new modifiers and when do we need to start using them?

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    Question

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

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    Question

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

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    Question

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

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    Question

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

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    Question

    How is CMS defining in whole or in part?

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    Question

    How is CMS defining a service?

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    Question

    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?

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    Question

    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?

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