Aetna has announced they will implement a payment reduction when outpatient therapy services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant. In this article, I will provide answers to the following questions:

Aetna has revised the effective date of their implementation to reduce payment when outpatient therapy services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant. Click HERE to read the updated article with the new effective date.

Article Updated on October 26, 2023 Aetna has announced they will implement a payment reduction when outpatient therapy services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant. In this article, I will provide answers to the following questions:

UnitedHealthcare (UHC) has announced they will reduce payment when services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant to UHC Medicare Advantage beneficiaries. In this article, I will answer the following questions: When is the effective date of the payment reduction? What is the payment reduction? Will this payment reduction apply to outpatient therapy claims submitted on a 1500-claim form? Does this policy apply to out-of-network (OON) providers? Will this payment reduction apply to outpatient therapy claims submitted on a UB-04 claim form? Does this policy apply to UnitedHealthcare Commercial plans?

On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2022 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). This rule does apply to outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except a critical access hospitals. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. Highlights of the final rule include, but are not limited to, the following: CO and CQ Assistant Modifiers Payment Reduction Calculation Adding Therapy Services to the List of Medicare Telehealth Services Therapy Codes Removed

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

Effective with dates of service on and after April 16, 2020, TRICARE recognizes physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) as TRICARE-Authorized Providers. On April 22, 2020, TRICARE updated their Policy Manual to include PTAs and OTAs. Highlights of the Policy Manual update include the following: Scope of practice of a PTA and OTA Supervision requirements of the PTA and OTA based on practice setting Reimbursement for services provided by a PTA or OTA Application of the CQ and CO modifier when services are provided in whole or in part by a PTA or OTA, respectively Payment differential