This line level field is used to represent the 15% reduction amount for physical therapy assistant (PTA) and occupational therapy assistant (OTA) services when modifiers CO or CQ are present.
Comments
Applies to types of bill (TOB)s; 13x, 22x, 23x, 34x, 74x, and 75x. This only appears on outpatient claims. This field is not populated prior to 2021.
The TOB is the concatenation of two variables:
Facility type (CLM_FAC_TYPE_CD)
Service classification type (CLM_SRVC_CLSFCTN_TYPE_CD).
Effective January 3, 2023, this field will include the Rural Emergency Hospital (REH) 5% payment increase. Applies to claims processed by the outpatient prospective payment system (OPPS), identified by provider type of “24K”, CLM_OP_PPS_IND = 2, and TOBs 13X and 14X.
Applies to types of bill (TOB)s; 13x, 22x, 23x, 34x, 74x, and 75x. This only appears on outpatient claims. This field is not populated prior to 2021.
The TOB is the concatenation of two variables:
Facility type (CLM_FAC_TYPE_CD)
Service classification type (CLM_SRVC_CLSFCTN_TYPE_CD).
Effective January 3, 2023, this field will include the Rural Emergency Hospital (REH) 5% payment increase. Applies to claims processed by the outpatient prospective payment system (OPPS), identified by provider type of “24K”, CLM_OP_PPS_IND = 2, and TOBs 13X and 14X.
VALUES: X.XX
SOURCE: NCH