Reimbursement Policy Update: Facility Reimbursement for PTAs and OTAs Assistants, Modifiers CO and CQ

Effective February 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a revision to the reimbursement policy Facility Billing Guidelines. The change will apply to services provided by Physical Therapy Assistants (PTAs) and Occupational Therapy Assistants (OTAs).

Services administered in whole or in part by a PTA or OTA must be submitted with modifier CO or CQ and will be reimbursed at 85 percent (85%) of the allowable amount. This policy applies to facility claims only. This policy will not apply to professional claims. Please see the related policy notification for more information. 

Blue Cross NC is implementing this change to ensure consistent and transparent reimbursement practices. Submitting with modifier CO and CQ will ensure providers are being accurately and fairly reimbursed for services. This aligns with Blue Cross NC’s mission to make healthcare more affordable for all.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). This will not apply to IPP Home. Modifier CO and CQ reimbursement is already applicable to Medicare Advantage.