Application of PTA and OTA Modifiers in 2020

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The pre-Recorded content and the recorded live Q and A are now available for viewing and listening.

Pursuant to the Bipartisan Budget Act of 2018 Section 53107, beginning on January 1, 2020, outpatient therapy providers are required to use a modifier (CQ or CO) to denote when outpatient therapy services are furnished in whole or in part by a PTA or OTA, respectively. In 2022, payment for outpatient therapy services furnished in whole or in part by a PTA or OTA will be reimbursed at 85% of the fee schedule. The reduced payment rate is applicable when payment is made under the PFS to therapists in private practice, outpatient hospitals, rehab agencies, SNFs, HHAs, and CORFs.

This webinar will focus on what outpatient physical therapy providers need to know in order to comply with Medicare’s new regulation regarding application of the CQ or CO modifier on the claim, including the 10% de minimis standard and how to determine whether services are considered furnished in whole or in part by a PTA or OTA. The final policy, as promulgated in the 2020 Medicare Physician Fee Schedule Rule, will be discussed and possible billing scenarios will be reviewed.

This course is free and is open to members and non-members.

Kara Gainer

JD, APTA Director of Regulatory Affairs

Kara leads, manages, and provides strategic direction to the regulatory affairs team on key programs and initiatives in the federal regulatory space that help to move forward the priorities of the APTA for the advancement of our profession in the area of payment and public policy. She also is responsible for leading member initiatives and developing policies and programs that promote the practice of physical therapy. Prior to joining APTA, Kara was a health care consultant with Drinker Biddle and Reath, where she developed and executed comprehensive public policy strategies for her clients that integrated legislative, regulatory, and communications efforts. She also served as an Attorney Advisor for the US Department of Health and Human Services Office of Medicare Hearings and Appeals and clerked with the U.S. Senate Sergeant at Arms.

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