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  • APTA Advisory: PTA, OTA Home Health Maintenance Therapy Codes Released for Use Beginning in October

    CMS MACs now have the G-Codes to allow HHAs to record the change that began on January 1. But don’t use them yet.

    Since January, a rule change long supported by APTA has been in place that allows PTAs and occupational therapy assistants to provide maintenance therapy for home health agencies under Medicare Part A, with certain restrictions. But something was missing — namely, the distinct codes that indicate when that type of service was being delivered.

    The codes are now identified, but it’s premature to start using them quite yet.

    Last week, CMS issued a change request to its Medicare Administrative Contractors with instructions for HHAs on the G-codes that indicate when maintenance therapy is provided by a PTA or OTA. The codes were introduced to help CMS more accurately track how much maintenance therapy is being provided by therapy assistants.

    The two new G-codes are:

    • G2168: "Services performed by a physical therapist assistant in the home health setting in the delivery of a safe and effective physical therapy maintenance program, each 15 minutes." (short descriptor: Svs by pt in home health)
    • G2169: "Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes." (short descriptor: Svs by ot in home health)

    The change goes into effect on October 5, and applies to dates of service as far back as January 1, 2020. In the meantime, HHAs should continue to report G0157 and G0158 for PTA or OTA services provided in 2020.

    [Editor's note: While the rule change that started in January opens up the possibility for maintenance therapy provided by therapy assistants, certain requirements need to be met: the services must be provided by way of a maintenance program established by a qualified therapist under the Medicare home health benefit, and the services must be permitted by the relevant state practice act.]

    Comments

    • What a great addition to our tool kit.

      Posted by Carolyn DockinsMSPT on 5/6/2020 2:58 PM

    • This article says "under Medicare Part A". Is that accurate?

      Posted by Brenda Paitsel PTA on 5/7/2020 6:56 PM

    • @Brenda: Yes. CMS stated in the CY 2020 Home Health PPS final rule that it would be appropriate to allow therapist assistants to perform maintenance therapy services under a maintenance program established by a qualified therapist under the home health benefit (Part A). Under normal circumstances, PTAs are not eligible to furnish maintainance therapy under Medicare Part B, although during the COVID-19 public health emergency, CMS has waived that restriction to allow PTAs to furnish maintenance therapy also under Part B.

      Posted by APTA staff on 5/8/2020 8:20 AM

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