National Legislative News

2023

AOTA Partners with Members for Payment Advocacy 
The AOTA Regulatory Affairs staff team closely monitors Medicare, Medicare Advantage, Medicaid, and commercial insurance plans for policy changes, such as NCCI coding edits that impact occupational therapy reimbursement. With regional commercial plans and state-specific Medicaid reimbursement, however, policies can vary widely, so the Regulatory Affairs team also relies on AOTA members and state associations to alert us to upcoming policy changes that will impact the provision of OT services and priorities for payment advocacy. Thanks to one member’s outreach, AOTA was recently able to address a problematic coding edit present in the national Medicaid NCCI edit table when CPT code 97530 (therapeutic activities) is billed by occupational therapy practitioners on the same day as CPT code 97533 (sensory integration). While the Medicaid NCCI edit rules do allow this code pair to be billed together with the use of a modifier to identify the services are separate and distinct from each other, the AOTA member was experiencing significant administrative burden in determining when to appropriately append the modifier on claims because the edit, present on the Medicaid NCCI edit table, was no longer being utilized by Medicare, which the member also bills for her services. Even when the modifier was correctly appended to claims with this code pairing, the member was experiencing delays with payment from Medicaid payers due to increased payer requests for medical records to support modifier use prior to paying the claims.

For more information on this issue, visit AOTA.

Effective Jan 1, 2022 new legislation was enacted that affected billing for OTAs. AOTA has been taking action in order to protect OTA billing. For more information, please visit AOTA's page: Capital Report: Congress Introduces Legislation to Protect OTAs From Pending Medicare Cuts | AOTA (you will need to be an AOTA member to login.)