MEDICARE DEMO NEW INFORMATION, MAY 13, 2005
The ACA has just learned some concerning news regarding the "incident to" provision regarding physical medicine.Upon reading Change Request 3648 (http://www.cms.hhs.gov/manuals/pm_trans/R34BP.pdf) on page 28, we found the following statement: "The services of a PTA shall not be billed as services incident to a physician/NPP’s service, because they do not meet the qualifications of a therapist." And on page 37: "The services of PTAs and OTAs also may not be billed incident to a physician’s/NPP’s service."
CMS's response to our inquiry on this Change Request was that there was a miscommunication and that, in fact, PTAs cannot provide the services incident to a chiropractor. In an e-mail to the ACA, a CMS employee writes:
"Unfortunately, I did say, "If the PTA has graduated from a PT curriculum" which was misleading. After discussing this with CMS staff, if a PTA has graduated from a PT curriculum (not a PTA curriculum), they would be a PT, not a PTA, just without a license. I never intended for this to mean a PTA curriculum. The requirements for the two curriculum are very different."
The ACA wanted to alert you and ask that you also please alert doctors in your area to this important information.
The ACA will be sending out a memo on this matter to all state associations for distribution next week.
The ACA continues to strongly object to CMS's "incident to" regulations and their application to the demonstration project. We will be sending a letter to CMS Administrator, Mark McClelland on this matter.
If you have any questions or concerns, please contact me and I would be happy to assist.
Thank you,
Amy
AMY HANLEY | Assistant
Director, Government Relations
AMERICAN CHIROPRACTIC ASSOCIATION
1701 Clarendon Boulevard | Arlington, Virginia 22209
T: 800.986.4636 x250 | F: 703.243.2593 | E: ahanley@acatoday.com