Humana Issues 2 New Policies Impacting Outpatient Therapy
Humana has issued 2 new policies that have an impact on outpatient therapy services. Both policies apply to Humana Medicare Advantage plans and Humana Commercial plans.
CQ/CO Modifier
Effective with dates of service on and after
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Missed Appointments
Humana’s Medicare Advantage and Commercial Payment Policies both allow a provider to bill
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Critical Access Hospitals are not required to submit the CQ or CO modifiers for CMS, per our coding team and our state Rural Health Cooperative. Would this apply to this Humana policy as well or do CAHs have to start submitting as well for Humana?
Per the policy: The following policy applies to every charge for an occupational or physical therapy service paid on an outpatient basis reported
on either a professional or an institutional claim except for an institutional type of bill 85x claim. 85x is a critical access hospital.
The policy doesn’t specifically include/exclude Humana Supplement plans. Are you aware of it those plans also fall under this policy?
You would need to contact Humana for that answer. Typically, a payer will follow the primary insurance carriers billing rules and regulations.
Does this apply to critical access hospitals?
Per the policy: The following policy applies to every charge for an occupational or physical therapy service paid on an outpatient basis reported
on either a professional or an institutional claim except for an institutional type of bill 85x claim. 85x is a critical access hospital.
Outpatient physical therapy in Alabama. Please clarify. Confusing.
What is confusing?
How does this work if the PTA/OTA only perform part of the treatment?
Same process as with Medicare patients.