AdministrativeCommercialJuly 1, 2024

Important changes to payment structure for PT, OT, and ST

This is to inform you of changes to our payment model for physical therapy (PT), occupational therapy (OT), and speech therapy (ST) that we believe will greatly simplify operations between our organizations.

Effective for dates of service on or after October 1, 2024, we will transition from a fee-for-service model to a per-diem (per day), flat-rate system. This means that instead of receiving payments based on each individual service provided, you will now receive up to an $80 daily per diem for those services. This change in methodology does not impact the way claims are submitted to Anthem. You should continue billing claims with the applicable reimbursement codes, modifiers, and units as is done today.

Our new methodology is aimed at providing more predictability and ease of management for both you and our organization. We believe this new model is in line with our continued commitment to providing the best services to our patients and a fair compensation structure for our dedicated professionals.

We want to take this opportunity to thank you for your continued dedication and outstanding care for our members. It is our hope that this new payment model will improve our services and allow us to further enhance the quality of care we provide to our members.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CTBCBS-CM-061928-24-SRS61877

PUBLICATIONS: July 2024 Provider Newsletter