2020 PT/OT Modifiers

January 13, 2020
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New CQ/CO Modifiers

For dates of service starting 1/1/2020, Medicare is requiring new modifiers on claims for treatment provided by a PTA or COTA.  The PTA modifier is CQ and the COTA modifier is CO.  (The GP, GO and KX modifiers will continue to be required.)  The need for the CQ/CO modifier is determined for each unit.  For example, if during one visit a patient receives a unit of manual and therex from a PT and a PTA does a second unit of therex, the CQ modifier only goes on the PTA’s unit of therex.

Although CMS originally proposed requiring additional documentation noting that a PTA or COTA provided the treatment, this is no longer the case.  PT/OT practices only need to have a mechanism to track when a procedure is provided by a PTA or COTA to trigger addition of the CQ or CO modifier.

GP/GO Modifiers

The GP modifier will still be required for all PT claims and the GO modifier will still be required for all OT claims.  So, claims for PTA services need to have both the GP and CQ modifiers on each line item. Claims for COTA services need to have both the GO and CO modifiers.

KX Modifier

As in prior years, the KX modifier will be required in 2020.  The threshold for adding the KX modifier has been increased from $2,040 in 2019 to $2,080 in 2020.  This threshold continues to apply separately to PT and OT.