This new policy becomes effective 09/01/2019 and applies to outpatient facility providers. Multiple procedure payment reduction guidelines for multiple therapies apply to physical, occupational, and speech therapy services designated as Always Therapy that are reported by the same provider, for the same individual, on the same date of service.
In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
CO Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
CQ Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
GN Service delivered personally by a speech-language pathologist or under an outpatient speech-language pathology plan of care
GO Service delivered personally by an occupational therapist or under an outpatient occupational therapy plan of care
GP Service delivered personally by a physical therapist or under an outpatient physical therapy plan of care