How to Bill for Services Provided By a PTA or OTA

March 18, 2019
Rick Gawenda

A question I often receive is how do I bill for services provided to a Medicare or non-Medicare beneficiary that were provided by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). The answer to the question depends upon your practice setting.

In a private practice setting (you submit claims on a 1500-claim form to the insurance carrier), the services of a PTA or OTA are billed

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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  1. When you say “billed under the NPI of the supervising/NPI of the facility” – Should the NPI go in the Supervising box or in the Treating box of the claim form?

    1. Please look at the 1500-claim form of where the NPI goes. The NPI of the treating/supervising therapist goes in Box 24J of the 1500-claim form.

  2. With the new Modifier rule for PTAs coming into effect soon, will the 15% reduction in reimbursement affect both private practice (Billing on 1500 claim form) as well as non-private practice settings (i.e. rehab agencies – billing on UB-04)?