Virginia Achieves Milestone in Reimbursement

June 10, 2024 by Beth Sitzler
VATA, NATA Share Reimbursement Progress

On May 3, Virginia Athletic Trainers’ Association Third Party Reimbursement Committee Chair Brice Snyder, MSAT, LAT, ATC, announced recent third-party reimbursement developments within the state, which resulted from the collaborative efforts of VATA Third Party Reimbursement Committee, contractors, VATA lobbyists, NATA Third Party Reimbursement Initiative and the VATA Executive Council.

Since January 2023, when an amendment to the state’s insurance code went into effect, VATA and NATA have worked with the key stakeholders of insurance companies and the Virginia Bureau of Insurance to finalize details and communicate what ATs do and how they would bill claims.

"The recent developments in third party reimbursement for athletic trainers in Virginia are a testament to the power of collaboration and advocacy,” said NATA President Kathy Dieringer, EdD, LAT, ATC. “VATA, NATA, and our dedicated partners have worked tirelessly to ensure that athletic trainers are recognized and reimbursed for the essential services they provide. This is a significant step forward in expanding opportunities for athletic trainers and enhancing patient care. We are grateful for the commitment and cooperation of all involved, especially Anthem Health Plans of Virginia and HealthKeepers Inc., for their thorough evaluation and support in clarifying these reimbursement procedures."

As a result, Anthem Health Plans of Virginia and HealthKeepers Inc. released the following statement:

"Anthem Health Plans of Virginia and HealthKeepers Inc. (Anthem), have reviewed their procedures to clarify how athletic trainers can receive reimbursement for the covered services they provide. The care provided must be within the scope of licensure and medically necessary, and follow one of these two scenarios:

  1. Claims for covered services rendered by athletic trainers in a physician's office: To be paid in-network, should continue to bill through a contracted physician's individual National Provider Identifier.
  2. Claims for covered services rendered by athletic trainers in a therapy (e.g., outpatient rehabilitation/ physical therapy) office setting: To be paid in-network, service provided by the athletic trainer must continue to be billed through a contracted therapy group's NPI.

Athletic trainers will use Athletic Training Evaluation/Re-Evaluation Codes (97169, 97170, 97171, and 97172) and subsequent 97XXX PM&R codes available to them and follow documentation processes consistent with physical therapists and occupational therapists. In these scenarios, athletic trainers would work under a referral/consult and deliver rehabilitation services under a plan of care developed by the athletic trainer.

The Virginia Athletic Trainers' Association (VATA) and representatives of NATA have worked closely with Anthem to clarify how athletic trainers can receive reimbursement for the services they provide. It has been a very collaborative journey. Both NATA and VATA wish to express their sincere appreciation to all of Anthem for its thorough evaluation."

“These avenues … are a start down a path that leads to expanded recognition and reimbursement for our professionals,” Snyder said in his memo to the VATA membership. “There are many possibilities for ATs to work into a scenario in which they can treat patients with commercial insurance and get paid for their services.”

With this task completed, Snyder said VATA will now shift to other goals and opportunities that revolve around ATs and reimbursement from different payers.

For more information and educational resources, visit the VATA website and NATA TPRI webpage.