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PTA/OTA 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. 

Proposed 2022 Rule

    • Billing Examples

Who must use 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

    Treatment Notes

      • Final Rule
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