All PlansReimbursementMedium impact
Payment Policy Material Amendment
Arkansas Blue Cross Blue Shield·AR · Physical Therapy, Occupational Therapy·Payment Policy
Effective date
Nov 1, 2026
We identified it
Aug 1, 2026
Summary
Arkansas Blue Cross and Blue Shield clarified that Policy #AR_PC_000016 for incident-to PTA and COTA services now explicitly applies to all outpatient professional services, including home health services billed on UB-04 or 837I claims. Effective November 1, 2026, all covered incident-to services will be reimbursed at 85% of the calculated PT/OT allowable amount across all lines of business, standardizing reimbursement methodology that previously had inconsistent application.
Action Required
By October 15, 2026: Billing team must update claim processing rules in billing software to ensure all PTA and COTA incident-to services—including home health services billed on UB-04 (837I electronic claims)—are reimbursed at 85% of the PT/OT allowable amount across all lines of business (Medicare Advantage, Commercial, Medicaid). Review current billing logic to identify any variations in application across line-of-business codes and standardize to the 85% reimbursement rate. Update billing team documentation and provider communications to reflect the expanded policy scope. Verify that home health claims on UB-04 forms are being processed under this policy; claims processed incorrectly prior to November 1, 2026 may require retroactive adjustment.