September 16, 2021
Following current Centers for Medicare & Medicaid Services (CMS) criteria, physical therapy services and occupational therapy services that are furnished in whole or in part by a therapy assistant, either a physical therapy assistant (PTA) or an occupational
therapy assistant (OTA) must be submitted with one of the following modifiers appended to the procedure code:
- CQ – Outpatient physical therapy services furnished in whole or part by a physical therapist assistant.
- CO – Outpatient occupational therapy services furnished in whole or part by an occupational therapist assistant.
In addition, these physical therapy and occupational therapy services must be appended with one of the following plan of care modifiers to indicate the services are part of a defined plan of care:
- GP – Service delivered under an outpatient physical therapy plan of care.
- GO – Service delivered under an outpatient occupational therapy plan of care.
Effective with claim dates of service on and after January 1, 2022, these therapy assistant modifiers will be reimbursed at 85% of the provider’s applicable contracted fee schedule amount, following the upcoming CMS reimbursement criteria.
Log into your One Health Port account to review the specific details on how to bill for therapy assistant services in the policy.