Assistant Modifier Payer Rules

Beginning January 1, 2022, CMS will discount procedures performed in whole or in part by an assistant by 15%. These procedures are indicated by a CQ or CO modifier on the line of service. CMS will allow the assistant modifier to be applied on a unit basis rather than a procedure basis and will also allow these procedures to be billed on separate charge lines based on the presence of the assistant modifier. For more information on the assistant modifier rule, please see the 2020 CMS Final Rule, pages 446-471.

To accommodate this rule, payer settings “Use CQ/CO Assistant Modifier Rule”, and “Separate Therapist/Asst. Charges” can be used to separate charge lines for Medicare category payers when a CO or CQ modifier is applied.

  • With these payer settings enabled, when a procedure is indicated as having been performed by an assistant, a CO or CQ modifier will be applied on a per unit basis. All units of a service with a CO or CQ modifier applied will be rolled into a separate charge line. If all units are attributed to the assistant, there will be only one charge line with the CO/CQ modifier applied.
  • The “Separate therapist/asst. charges" rule is for timed service codes only. Untimed codes will follow the existing behavior of the parent setting, “Use CQ/CO assistant modifier rule”. If only this parent setting is checked, it will apply to both timed and untimed codes.
  • The CQ/CO modifier is not visible in the Chart, but therapists will see a warning notifying them that it will be applied after the visit is signed.

Note: Clinicient will apply these settings to Medicare and Medicare Replacement/Advantage category payers for all Total INSIGHT™ users. INSIGHT™ and INSIGHT users must make sure this setting is checked for their Medicare and Medicare Replacement/Advantage payers in order to implement the new assistant modifier rule.

How to Apply Assistant Modifier Rules

Click play below to see a video walkthrough on how to apply assistant modifier payer settings.

The assistant modifier rules can be applied to a selected payer under the Billing Flags section of the General Billing Data tab in the Edit Payers window. To search for payers with the assistant modifier rules applied or apply these rules to multiple payers, follow the steps below.

  1. Open Edit Payers and select Browse Payers.

  2. In the Billing Data tab, scroll horizontally to the Use Assistant Modifier and Separate Therapist/Assistant Charges columns.

  3. Use the checkboxes in these columns to apply rules to select payers.

Related Links

General Billing Data Tab

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