December 7, 2011

 

HHA-11-11

 
 

To:

All Blue Cross and Blue Shield of Kansas Contracting Providers

From:

Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association

Subject:

Services provided by a Certified Physical Therapist Assistant (CPTA) or a Certified Occupational Therapist Assistant (COTA) in a Home Health setting for FEP (Federal Employee Program) members.

The Home Health Services benefit described on page 48 of the 2011 Blue Cross and Blue Shield Services Benefit Plan for FEP members specifically states that services provided by a nurse, nursing assistant, health aide or other similarly license or unlicensed person that are billed by a skilled nursing facility, extended care facility or nursing home (except as included in the benefits described on page 75) are not covered.  This benefit is very clearly limited to a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) and cannot be extended to any other type of provider.

Reimbursement for claims with services provided will not be covered if submitted with procedure code G0157 for home nursing claims if the service is performed by CPTA or a COTA.  The FEP benefit brochure is very specific as to what providers are eligible to perform services in the home and services being performed by a CPTA or a COTA in the home is listed as contract exclusion.  When verifying member benefits it is also important to verify the restrictions of a benefit, such as provider eligibility.

If you have questions, please contact your Blue Cross and Blue Shield of Kansas provider representative.

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