CQ and CO Modifiers

Beginning in 2020, CMS requires modifiers to be applied to services provided by a PTA or COTA for patients with Medicare as the primary or secondary insurance. These modifiers, CQ and CO respectively, should be applied to any service where 10% or more was provided by the assistant.

  • CQ modifier: Services furnished in whole or in part by a PTA 
  • CO modifier: Services furnished in whole or in part by a OTA
Important: The availability of these modifiers is enabled for Medicare-type insurances by default. For all other insurances, this feature must be enabled manually. For more information, please see: Insurance Settings in WebPT
To comply with CMS 2022  rules around Assistant Modifiers, the WebPT EMR can now identify both therapist and assistant contributions for each CPT code. The WebPT EMR will then use the minutes you provide to auto-calculate which units should have the Assistant Modifier, and which should not. This CO/CQ Modifier feature will not be present for dates of service prior to January 1st, 2022.  Updated guidance for applying CO/CQ assistant modifiers can be found here for members using SOAP 1.0 and  here for members using SOAP 2.0. These articles provide scenario-specific information on when you can see the split minutes on the note. 

Let’s review how these modifiers may be added to your documentation.

Scenario 1: Assistant Forwarding a Note

  1. A PTA (or OTA) begins a note in the WebPT EMR and enters charges for the services provided.
    Note: Modifiers won’t appear until the note is forwarded.
  2. The PTA or OTA will forward the note to a supervising therapist.
  3. The supervising therapist will open the note by clicking Incomplete Cosign Documents in the "At a Glance” alerts section of the Dashboard.
  4. The supervising therapist will see the assistant modifiers on the Billing tab (or Objective tab for Daily Notes). The CQ or CO modifier will display the Assistant Minutes and Therapist Minutes next to each charge automatically. You can then record the therapist versus assistant minutes for each code as seen in the example.

Note: If a charge is added in an addendum to this note by a PT or OT, the modifier will not be automatically applied. The CO/CQ modifiers will be available for selection if needed.

Scenario 2: Assistant Finalizing a Note

If you have enabled the ability for an assistant to finalize notes, the CQ or CO modifier will be automatically added to all CPT codes.

I bill Medicare Part A, do I need to use the CQ and CO modifiers?

If you bill Medicare Part A for your services (e.g., rehab agencies, CORFs), you will need to use the CQ/CO modifiers for any services furnished by a PTA or OTA. The requirement applies to payments for physical and occupational therapy in private practice, outpatient hospitals, rehab agencies, skilled nursing facilities, home health agencies, and comprehensive outpatient rehab facilities.

Billing Part A for outpatient therapy services does not exempt the practice from this requirement as payment is still made on the Part B physician fee schedule.

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