Language in the Bipartisan Budget Act of 2018 instructed the Secretary of Health and Human Services (HHS), by January 1, 2019, to establish a modifier to indicate (in a form and manner specified by the Secretary), in the case of an outpatient physical therapy service or outpatient occupational therapy service furnished in whole or in part by a PTA or OTA, that the service was furnished by a PTA or OTA. The CQ and CO modifiers were created by the Secretary of HHS and became effective with dates of service on and after January 1, 2020 for traditional Medicare outpatient therapy services.

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?

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 Missed Appointments Humana’s Medicare Advantage and Commercial Payment Policies both allow a provider to bill I hope you enjoyed this article. Thank you for being a Gold Member!

Beginning with dates of service on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will require providers of outpatient physical therapy and occupational therapy services to append a modifier to CPT code(s) on the claim form when that service was provided in whole or in part by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). Click HERE to access my answers to some of the more frequently asked questions on the new PTA and OTA modifiers. In this article, I will provide 14 scenarios and the answer how to correctly bill for

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS) and the Merit-Based Incentive Payment System (MIPS) program for calendar year (CY) 2020. Highlights of the final rule include, but are not limited to, the following: 2020 Medicare Conversion Factor 2020 Annual Therapy Threshold Dollar Amount Dry Needling CPT Codes CO/CQ Documentation Requirements New PTA and OTA Modifiers Effective January 1, 2020 Discipline Specific Therapy Modifiers (GO and GN) Biofeedback CPT Codes Cognitive Function Interventions Negative Pressure Wound Therapy Here we go! 2020 Conversion

Effective with dates of service beginning on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will require 2 new modifiers 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) or an occupational therapy assistant (OTA). To make matters worse, beginning with dates of service on and after January 1, 2022, services that contain one of the two modifiers appended to them on the claim form will be paid at 85% of the normal rate of the Medicare allowed amount

On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices, hospital outpatient departments (including Medicare beneficiaries under Observation status and in the Emergency Department and do not get admitted to the hospital), skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in a Medicare beneficiaries home. Highlights of