Effective September 1, 2019, Independence will implement new claim payment policies for multiple therapies for outpatient facility providers, specifically to include physical, occupational, and speech therapy services. These claim payment policies apply to specific CPT^® and HCPCS codes that are designated by the Centers for Medicare & Medicaid Services (CMS) as “Always Therapy” for these services. Independence will include full payment for the procedure with the highest total allowance and reduced payment as described below for each subsequent procedure.  

The following policies were posted to our Medical Policy Portal as Notifications on August 1, 2019, and will go into effect September 1, 2019:

• Commercial: #00.01.68: Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
• Medicare Advantage: #MA00.050: Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services

Claims processing

Facility outpatient therapy claims when multiple physical, occupational, and speech therapy services are reported by the same provider, for the same member, on the same date of service will be processed as follows:

• The procedure code with the highest total allowance is eligible for reimbursement at 100 percent of the provider's applicable contracted rate.
• Each subsequent procedure code is eligible for reimbursement at 50 percent of the provider's applicable contracted rate.

In addition, multiple procedures may be submitted on one claim or on multiple claims. These claim payment policies for services designated as “Always Therapy” are based on the date of service regardless of the date the claim was submitted or received.

Learn more

To view the Notifications for these policies, visit our Medical Policy Portal.

Refer to Attachment A of these policy documents to see the list of CPT and HCPCS codes for multiple therapies to which the claim payment policies described above apply.

For further questions about these new claim payment policies, review our New claim payment policy for multiple therapies: Frequently asked questions (FAQ), which can also be found in the Frequently Asked Questions archive on Independence NaviNet^® web portal (NaviNet Open) Plan Central or in the Quick Links menu on the right-hand side of this page. The FAQ will be updated as more information becomes available. 

If you still have questions after reviewing these resources, please call 1-800-ASK-BLUE.

CPT Copyright 2017 American Medical Association. All rights reserved. CPT^® is a registered trademark of the American Medical Association.

NaviNet^® is a registered trademark of NantHealth, an independent company.