Payment differential would proceed in 2022
Despite serious questions and criticisms from APTA, the American Occupational Therapy Association (AOTA), and other stakeholders, the US Centers for Medicare and Medicaid Services (CMS) intends to move ahead with its plans to require providers to navigate a complex system intended to identify when therapy services are furnished by a physical therapist assistant (PTA) or occupational therapy assistant (OTA).
The approach, which in 2022 would trigger a payment differential depending on how many minutes of services are provided by a PTA or OTA, is included in the proposed 2020 physician fee schedule rule released by CMS on July 29.
For physical therapists, the emphasis for the 2020 proposed rule is related to how CMS plans to require providers to comply with a law requiring identification of services furnished “in whole or in part” by a PTA or OTA. The approach being contemplated by CMS—to set a 10 percent bar—has been criticized by APTA as one that has “serious implications for beneficiary access to care,” particularly in rural and underserved areas.
The proposed 2020 rule would require the new PTA and OTA modifiers (CQ and CO, respectively) to be included in claims beginning January 1, 2020, with a payment differential implemented in 2022. CMS also proposes to add a requirement that the treatment notes explain, why the modifier was or wasn’t used for each service furnished that day. In short, the system is rooted in minutes of service, and would require the use of the applicable modifier that would indicate when a PTA or OTA provided outpatient therapy services for 10 percent or more of the total time spent furnishing the service.