The CMS Proposes Some New Rules for 2019

Please note that this article contains information that is only relevant to American clinics.


The Center for Medicare and Medicaid Services (CMS) is always tinkering with their rules and regulations. Not only do they seek to make things simpler for the therapists, they also aim to improve the quality of care for outpatient PT, OT, and SLP Medicare patients across the board. These improvements tend to be released on a yearly basis, and the summer always presents an excellent opportunity for the CMS to propose new rules for 2019.


First and foremost, the CMS is doing away with Functional Limitations Reporting (FLR). Clinics will be pleased to know that as of January 1, 2019, they no longer have to record the G-Codes for their PT, OT, and SLP patients.


Click here to read about PTAs, OTAs, and SLPAs providing therapy in patients’ homes.


Secondly, there are going to be some new modifiers. These will indicate that a service was completed by an assistant and not a full-fledged therapist. While the CMS has not revealed what the exact name of those modifiers are just yet, we do know that use of them will entitle your practice to 85% of the typical Medicare payment amount.


And last but certainly not least, the CMS has confirmed that they will begin rolling out the new Merit-Based Incentive Payment System (MIPS) in 2019. MIPS collection in 2019 will affect your reimbursement rates for 2021 so PTs, OTs, and SLPs will need to take this as an opportunity to familiarize themselves with MIPS.

Do you know how to include therapy assistants on invoices? Click here to watch our tutorial video.


We hope that this article provides you with some hints for what you can expect from the CMS in 2019. To learn more, we recommend checking out the Gawenda Seminars and Consulting website.

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