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Commercial insurer Aetna has announced that it will follow suit with changes originally adopted by the U.S. Centers for Medicare & Medicaid Services and institute a 15% payment reduction for any services delivered "in whole or in part" by a physical therapist assistant or occupational therapy assistant. The differential is set to begin Dec. 1 of this year.

News of the change was announced in Aetna's September "OfficeLink Updates" newsletter (see Page 8).

For PTs, the reduction will be triggered based on the use of a current procedural terminology code accompanied by the CQ modifier, which indicates that at least part of the services were provided by a PTA. The change will put Aetna's system in line with CMS changes to Medicare payment implemented in 2022, which the agency says were required by law through the 2018 Bipartisan Budget Act.

APTA opposed the changes adopted by CMS and is reaching out to Aetna to advocate for reconsideration of the reduction.


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