Skip to main content

In passing the Bipartisan Budget Act of 2018, Congress required that by January 1, 2019, the Centers for Medicare and Medicaid Services establish a modifier to indicate when an outpatient physical therapy service is furnished in whole or in part by a physical therapist assistant.

Starting January 1, 2022, outpatient physical therapy services covered under the Medicare physician fee schedule that are furnished at least in part by a PTA will be paid at 85% of the applicable fee schedule rate. (A similar modifier was designated for services provided by an occupational therapy assistant, which also will be subject to the 85% payment differential).

So that providers are prepared for 2022, use of the modifier was mandated as of January 1, 2020, for outpatient therapy providers across almost all settings — including private practices, skilled nursing facilities, home health agencies, outpatient hospitals, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities. The modifier is CQ for PTAs (CO for OTAs).

Log in or create a free account to keep reading.


Join APTA to get unlimited access to content.


You Might Also Like...

News

PTA Win: TRICARE Manual Reflects Change From Direct Supervision to General

Oct 29, 2025

On Sept. 18, Humana Military announced a change in TRICARE policy regarding the supervision requirements for physical therapist assistants in private practice.

Article

From Recovery to Prevention: APTA Report Charts New Course For Public Awareness

Oct 15, 2025

A newly released research report, APTA’s Consumer Perceptions Report, sheds light on how Americans perceive physical therapy — and where opportunities

Article

Cigna Implements Outpatient Hospital Physical Therapy Site-of-Care Review

Oct 14, 2025

Effective Oct. 1, Cigna Healthcare implemented a new site-of-care review process for outpatient hospital physical therapy and occupational therapy