As of September 1, 2019, AmeriHealth implemented a new claim payment policy for multiple therapies for outpatient facility providers, specifically to include physical, occupational, and speech therapy services. This claim payment policy applies to specific CPT® and HCPCS codes that are designated by the Centers for Medicare & Medicaid Services (CMS) as “Always Therapy” for these services. AmeriHealth will include full payment for the procedure with the highest total allowance and reduced payment as described below for each subsequent procedure.
Claim Payment Policy #00.01.68: Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services was posted to our Medical Policy Portal and went into effect September 1, 2019.
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. This claim payment policy 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 this policy, visit our
Medical Policy Portal.
Refer to Attachment A of this policy to see the list of CPT and HCPCS codes for multiple therapies to which the claim payment policy described above apply.
For further questions about this new claim payment policy, 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 AmeriHealth 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
1-888-YOUR-AH1 for AmeriHealth New Jersey and 1-800-275-2583 for AmeriHealth Pennsylvania.
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