Regulatory Update

New PTA and OTA Modifiers Required Beginning January 1, 2022

Polaris Group Profile
Polaris Group
December 14, 2021
September 14, 2022
Polaris Group Profile
Polaris Group
September 14, 2022
Summary

CMS has established and are implementing two new therapy modifiers for PTAs and OTAs providing services to therapy patients.

Download PDF
Download icon

CMS has established and are implementing two new therapy modifiers for PTAs and OTAs providing services to therapy patients. Using these new modifiers, CMS has reduced payment for occupational therapy and physical therapy services furnished in whole or in part by occupational therapy assistants (OTAs) and physical therapist assistants (PTAs) at 85 percent of the otherwise applicable Part B payment for therapy services effective January 1,2022.

 

These modifiers are defined as follows:

  • CQ modifier: Outpatient physical therapy services furnished in whole or in     part by a physical therapist assistant
  • CO modifier: Outpatient occupational therapy services furnished in whole or     in part by an occupational therapy assistant

 

The CQ and CO modifiers must be used when applicable for all outpatient therapy services for which payment is made undersection 1848 (the PFS) or section 1834(k) of the Social Security Act (the Act).As such, the modifiers are required to be used for therapy services furnished by providers that submit institutional claims, including the following provider types: outpatient hospitals, rehabilitation agencies, skilled nursing facilities, home health agencies and comprehensive outpatient rehabilitation facilities (CORFs). However, the CQ and CO modifiers are not applicable to claims from critical access hospitals or other providers that are not paid for outpatient therapy services under the PFS or section 1834(k) of the Act.

 

Effective for claims with dates of service on and after January 1, 2022, the CQ and CO modifiers are required to be used, when applicable, for services furnished in whole or in part by a PTA or OTA on the claim line of the service, along with the respective GP or GO therapy modifier, to identify those services furnished in whole or in part by a PTA or OTA under a physical therapy or occupational therapy plan of care. Claims without the required modifiers will not be processed or will be rejected/returned.

 

Chapter 5, Medicare Claims Processing Manual, section 20.1 -Discipline Specific Outpatient Rehabilitation Modifiers-All Claims.

continue reading

Sign-up for the Polaris Pulse Newsletter

We filter out the noise and provide you the information you need to keep you informed.

I want to subscribe to...
Great– your all set!
You will start receiving our Polaris Pulse Newsletter in your inbox.
Oops! Something went wrong while submitting the form.