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.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
Information in other languages: Español 中文 Tiếng Việt 한국어 Français العَرَبِيَّة Hmoob ру́сский Tagalog ગુજરાતી ភាសាខ្មែរ Deutsch हिन्दी ລາວ 日本語
© 2025 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.