Quick Guide to PTA Modifier
CMS requires the use of the CQ modifier to denote outpatient therapy services furnished in whole or in part by a physical therapy assistant in physical therapist private practices, skilled nursing facilities, home health agencies, outpatient hospitals, rehabilitation agencies, and comprehensive outpatient rehabilitation facilities. A similar modifier, identified as CO, is required for services furnished by an occupational therapy assistant.
When billing timed treatment codes, first determine the total number of units you can bill based on the 8 minute rule. Then determine, for each unit, whether the PTA furnished more than 10% of each unit independently of the physical therapist. This is the de minimis standard for determining “in part” services.
Only the minutes the PTA spends independent of the PT count toward the 10% de minimis standard.
Apply the 10% de minimis standard to untimed codes and to each billed unit of a timed code rather than to all billed units of a timed code.
If a PTA’s time spend furnishing care exceeds 10% of the total time spent furnishing an untimed code, apply the CQ modifier.
If a PTA’s time spend furnishing care exceeds 10% of a unit of service, apply the CQ modifier to the unit.
If a PTA’s time spent furnishing care is 10% or less of a unit of the service, do not apply the CQ modifier, even though the time is not billable.
When applicable, report the CQ modifier on the claim line of the service, next to the GP therapy modifier.
Apply CQ Modifer Do Not apply CQ Modifer
PT provides services in whole X
PTA provides services in whole X
PTA provides services independent from the PT that represents more than the de minimis X
PTA provides services independent from the PT that represents less than the de mimimis X
PT provides the whole of services described by a CPT Code claim line item X
PTA provides the whole of services described by a CPT Code claim line item X
PT furnishes care for the duration of the entire service or procedure and PTA furnishes care
jointly with PT for part of the time X
PT and PTA furnish care together for the entire duration of the service or procedure X
CMS has not established any new documentation requirements to accompany the new CQ modifier.
Examples
The PT and PTA each individually and exclusively furnish minutes of the same therapeutic exercise (CPT 97110) in different time frames: The PT furnishes 7 minutes and the PTA furnishes 7 minutes, for a total of 14 minutes. Billing - Report 1 unit of 97110 with the CQ modifier to signal that the PTA’s 7 minutes of furnished services exceed 10% of the 1 unit of service. The 7 minutes of 97110 furnished by the PT do not result in a billable service. However, document them within the total treatment time.
The PT furnishes 20 minutes of group therapy (CPT 97150) to three patients independent of the PTA, and the PTA furnishes 20 minutes of 97150 to the same three patients independent of the PT for a total of 40 minutes. Billing - Report 1 unit of 97150 with the CQ modifier for each patient in the group, because the PTA’s time exceeded the 10% de minimis standard. Document the total number of minutes furnished.
The PTA and PT work concurrently as a team to furnish the same neuromuscular reeducation service (CPT 97112) for a 30 minute session. Billing - Report 2 units of 97112 without the CQ modifier, because the PT furnished both units in whole while assisted by the PTA. The PTA’s time is irrelevant to billing.
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