Posted in #aetna, #Medicare, #Medicareadvantage, Payers and CPT reinbursement

Aetna Commercial and Medicare Plans: Payment for Occupational Therapy/Physical Therapy Assistants

As per Aetna Updates: starting December 1,2023 the Occupational Therapy Assistants and Physical Therapy Assistants will get their own reimbursement for performed services.

Reimbursement amount: 85% of Allowed amount.

Please append the following modifiers to the services that are performed by the PTAs and OTAs:

CO-occupational therapy services performed in part or as a whole by an Occupational Therapy Assistant

CQ-physical therapy services performed in part or as a whole by a Physical Therapy Assistant.

This change applies to Medicare and Commercial plan types.

Find this type of content useful? Follow my blog for more medical billing and coding updates/changes from various insurance payers.

Previous Blog Posts:

FidelisCare-concurrent prior auth update for family and group therapy services.

This update will apply to any dos of Jan 1, 2026 and thereafter. This update does not apply to SUD services/ providers that are certified as Article 32. 29-I providers are also excluded from the concurrent prior authorization requirenments. Services affected: Family Psychotherapy – CPT Code 90847 Group Psychotherapy – CPT Code 90853    FidelisCare members have 30…

Healthfirst Pharmacy Update Contrast agent reimbursement

The following information applies to the members in the following plans: Managed Medicaid Plans and Personal Wellness Plans (HARP) Back in 2023, NYS DOH announced that there will be a change to the pharmacy benefits for MMC, HARP members- the pharmacy benefits will be covered but NYRx. This change was finally implemented in April 2025.…

NYS Medicaid to cover TCM (Therapeutic Transcranial Magnetic Stimulation)

The information discussed below applies to straight NYS Medicaid members for the DOS 10/1/25 and effective for any DOS on or 11/1/25 and thereafter for any Managed Medicaid Members. What is TC? A non-invasive form of brain stimulation using magnetic pulses on specific areas of the brain. This therapy is used to improve the symptoms…

Posted in EmblemHealth NY, NY Providers, Training, Updates

EmblemHealth/Connecticare: Telehealth Reimbursement Policy Update for 2022

If you are a provider that accepts patients with EmblemHealth and/or Connecticare Insurance this blog post is for you!

This policy applies to Emblemhealth/Connecticare Commercial, Medicare and Medicaid Members.


Effective 01/01/2022- EmblemHealth/Connecticare has updated their telehealth policy. The following update was added:


Effective 06/01/2022- changes effect modifiers:

Want to learn more? Please click here to see the whole telehealth policy.


Recent Blog Posts: