Aetna announces delay to OTA payment reduction policy

UPDATE: 10/30/2023

Aetna has announced that they are delaying implementation of the OTA payment reduction until March 1, 2024. AOTA is closely monitoring the issue and will provide updates here as they become available.

Original story: 9/29/2023

Aetna, one of the five largest insurance companies in the country, recently announced (page 8) that it intends to implement the occupational therapy assistant (OTA) payment reduction, scheduled to take effect on December 1, 2023.

This policy was initially implemented in 2022 by the Centers for Medicare & Medicaid Services (CMS). Aetna's policy aligns with CMS and implements a 15% reduction in payments for services delivered, either entirely or partially, by occupational therapy assistants. For occupational therapists (OTs), the reduction will be applied when utilizing a CPT code combined with the CO modifier, signaling that an OTA provided a portion of the services.

As with the Medicare policy, AOTA is strongly opposed to the Aetna policy and is collaborating with industry partners to advocate for a reevaluation of the payment reduction policy. Please check back for updates as advocacy efforts progress.