Payment Policy Updates

  • Payment Policy updates from August

    NEW POLICY - Physical Therapy and Occupational Therapy Assistant Modifiers:  CQ and CO

    This new policy formalizes the required use of these therapy assistant modifiers when a physical therapy assistant or an occupational therapy assistant furnishes a part of or all of a therapy service. Licensed physical therapists and licensed occupational therapists will need to bill modifiers CQ and CO respectively to identify when they use assistants to render such therapy services. This mirrors Medicare requirements currently in place to identify therapy assistant services. 

    Effective with dates of service on and after January 1, 2022, these modifiers will be reimbursed at 85% of the provider's contracted allowed fee schedule amount. 

    Physical and Occupational Therapy Services

    This existing policy was expanded to include new sections on therapy assistant services and modifiers and plan of care modifiers.

    Prolonged Services for Labor Management

    Additional prolonged services codes 99415, 99416, 99417 and G2212 were added to the policy.

    Effective with claim dates of service on and after December 16, 2021, the codes 99415, 99416, 99417 and G2212 will not be reimbursed when billed for labor management.  

    Code descriptions for existing policy codes 99354, 99355 and 99356 were also revised.

    Sign in to your OneHealthPort account to review the full policy details.

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