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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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PTA (CQ) and OTA (CO) Medicare Modifiers

In 2022, Medicare will apply a 15% discount to payments for therapy that is provided, “in whole” or “in part”, by a PTA or OTA. To prepare for this change, claims for outpatient therapy services furnished “in whole or in part” by a therapy assistant must include the new modifier effective for dates of service beginning on January 1, 2020. 

Final 2022 Rule

    • Billing Examples

Introduction to the New Modifiers

    • The New Modifiers
    • Settings
    • When the Modifiers are Applied

Determining when to use the Modifiers 

    • De Minimis Standard
    • Method of Calculation
    • Total Time


How to use the Modifiers with Timed Codes

    • One service is furnished in a treatment day
    • When services that are represented by different procedure codes are furnished

    How to use the Modifiers with Untimed Codes

      • Evaluations and Re-evaluations
      • Group Therapy
      • Supervised Modalities

    Documentation

      • Treatment Notes


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