As of October 27, 2024, physical therapy assistants (PTAs) and occupational therapy assistants (OTAs) may provide services under the direct supervision of a Board-authorized physical therapist (PT) or Board-authorized occupational therapist (OT), respectively. See Subject Number 046-1724, Emergency Adoption and Proposal of Amendment to Section 329-1.3 of Title 12 of the NYCRR (Physical Therapy Assistants and Occupational Therapy Assistants).
Below are frequently asked questions to serve as initial guidance:
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Can PTAs/OTAs start treating on the effective date?
Yes, PTAs/OTAs can begin treating under the direct supervision of respective Board-authorized PTs and OTs.
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Do PTAs and OTAs need to register with the NYS Workers' Compensation Board to become Board authorized in order to treat injured workers?
No, PTAs and OTAs are not eligible for Board authorization, however, they may treat under the supervision of a Board-authorized PT and/or OT.
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How do PTAs and OTAs bill for services rendered?
First, the Board has updated the regulations in order to address treatment conducted by PTAs and OTAs.
When billing for PTA services, supervising authorized PTs must select codes from The Official NYS Workers' Compensation Physical and Occupational Therapy Fee Schedules that are permissible and within the scope of practice for PTAs using modifier CQ.
When billing for OTA services, supervising authorized OTs must select codes from The Official NYS Workers' Compensation Physical and Occupational Therapy Fee Schedules that are permissible and within the scope of practice of OTAs using modifier CO.
Services billed using the modifiers CQ or CO should be priced/billed and paid at 85 percent of the amount payable for such services had they been performed directly by PTs and OTs, that is, for the applicable PT and OT codes without the modifiers.
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Do supervising PTs/OTs need to co-sign clinic notes?
Yes, clinical notes by PTAs/OTAs should be cosigned by the supervising PT/OT. PTAs and OTAs may not provide services or bill for services independently. The maximum numbers of billable RVUs for physical therapy and occupational therapy on any given date of service, as outlined elsewhere in the fee schedule, remain the same and are not increased or otherwise changed based on whether the services are provided by PTs, OTs, PTAs, or OTAs. When services are performed by PTs and PTAs (or OTs and OTAs) on the same date of service, the services applied to the maximum number of RVUs on any given date of service should be determined giving priority to services provided by PTs over those provided by PTAs, and services provided by OTs over those provided by OTAs.
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Does the new legislation expand the scope of practice for PTAs and OTAs?
No, the ability of PTAs and OTAs to provide services under the NYS Workers' Compensation Law and regulations, and for supervising PTs and OTs to submit bills for said services, shall in no way expand or otherwise change the scope of practice or permissible activities for PTAs or OTAs by statute, and/or any applicable regulations promulgated by the New York State Education Department, New York State Department of Health, or the New York State Workers' Compensation Board.
As such, it shall be impermissible for PTAs/OTAs to perform any services or activities otherwise reserved for PTs and OTs respectively, or for supervising PTs/OTs to bill for such services, and CPT codes must be selected accordingly. Examples may include but are not limited to: a PTA is prohibited by section 6738(a) of the NYS Education Law from performing evaluation, testing, interpretation, planning or modification of patient/client programs; a PT conducts the initial evaluation and develops the plan of care, and the treatment may be provided by the PTA; PTAs and OTAs may not perform Functional Capacity Evaluations (FCEs).
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Can PTAs/OTAs submit Requests for Decision on Unpaid Medical Bill(s) (Form HP-1.0)?
No, the supervising PT/OT submits both the bill as well as any subsequent HP-1s.
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Can PTAs/OTAs submit prior authorization requests (PARs) for treatment/services?
No, only the treating physician can submit PARs (including MTG Variance, MTG Confirmation, DME, and Medication PARs) related to PT and/or OT. Additionally, supervising PTs/OTs are not eligible to submit MTG-related PARs but may submit non-MTG PARs over and under $1,000.