Reminder: non-physical, occupational or speech therapists must include modifiers on physical, occupational, or speech therapy claims

As recently reiterated in the December 2019 edition of Provider News, effective November 1, 2019, all qualified providers who perform physical, occupational or speech therapy services for Anthem members are required to request prior authorization review from AIM Specialty Health® (AIM). Prior authorization review requests for PT, OT and ST may be submitted to AIM via the AIM ProviderPortal_SM.  

 

The AIM Rehab Program follows the Anthem Clinical Guidelines that state the services must be delivered by a qualified provider of therapy services acting within the scope of their licensure. Qualified providers acting within the scope of their license, including chiropractors, who intend to provide PT, OT or ST services must request prior authorization for those services through AIM. All non-physical therapists, non-occupational therapists and non-speech therapists must submit claims that include therapy codes contained in CG-REHAB-04, CG-REHAB-05 or CG-REHAB 06 with the modifiers GP (physical therapy services), GO (occupational therapy services) or GN (speech therapy services). 

 

We are also transitioning vendors for review of rehabilitative services for our Medicare members to include outpatient PT, OT, and ST to AIM Specialty Health. The AIM Rehab program will begin in April 2020. Modifiers must be appended when submitting claims for services delivered under an outpatient occupational or physical therapy plan of care on a CMS -1500 form. Use modifier GP (physical therapy services), GO (occupational therapy services) or GN (speech therapy services).

 

Please see the notice in the Medicare section of this March 2020 issue of Provider News for more information about the AIM Rehabilitative Program for Medicare members.