Horizon BC BS NJ will change how it considers and reimburses certain professional claims based on our new reimbursement policy Modifiers CQ/CO.
Effective June 27, 2022, Horizon will change how certain professional claims are reimbursed, in line with the new reimbursement policy Modifiers CQ/CO.
According to the guidelines of this policy, from June 27, 2022, procedure codes included on claims for services rendered by a physical therapy assistant (PTA) or an occupational therapy assistant (OTA) must be appended with modifier CQ or CO as appropriate. Such services will be considered for reimbursement at 85% of the appropriate Horizon BCBSNJ fee schedule amount.
The guidelines of this policy apply to claims submitted by the following groups:
• Participating and nonparticipating practices/practitioners: for services rendered to patients enrolled in fully insured commercial plans, Administrative Services Only (ASO) employer groups, and Medicare Advantage plans, including Braven Health℠ plans.
• Participating practices/practitioners ONLY: for services provided to patients enrolled in New Jersey State Health Benefits Program (SHBP)/School Employees’ Health Benefits Program (SEHBP) plans.
You should review the details of the Modifiers CQ/CO reimbursement policy to understand the scenarios in which it would be appropriate to append modifier CQ or CO to procedure codes.
Source:
Discover more from Doctor Trusted
Subscribe to get the latest posts sent to your email.
