Major Payment Changes for CPT Codes in 2018

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


As if the news about the removal about the removal of Medicare’s therapy cap exceptions wasn’t bad enough, there are some big changes to the reimbursement payouts for several popular CPT codes. In this article, we’ll discuss two of the most-common CPT codes for PTs providing Medicare Part B services that are affected by these payment changes in 2018.


If you read our series on how the CMS determines the dollar value of each CPT code, then you’re no stranger to the “Resource Based Relative Value Scale” (RBRVS). The RBRVS accounts for factors such the skill and training required to perform certain types of treatment, along with the costs associated running a private practice facility in any given region. The CMS used this scale to make some changes to the payouts for some very popular CPT codes in 2018.


Two of the most common CPT codes billed by therapists are therapeutic exercise (CPT 97110) and manual therapy (CPT 97140). As per the updates to the CPT codes, the 2018 payment rate for CPT 97110 therapeutic exercise has been reduced by $1.97, and the payment rate for CPT 97140 manual therapy has been reduced by $2.38.


When you look at those numbers individually, it doesn’t seem like a whole lot. But when you do the math, $1.97 really begins ton add up. Let’s look at an example.


Say, for instance, that your therapists collectively provide 100 units of CPT 97110 therapeutic exercise per week. That loss of $1.97 per unit just because a loss of $197.00 for the week. Within 1 month, that represents a loss of $788.00. And over the course of a year, nearly $10,000—and of course, this is assuming that your facility is being compensated the full amount to begin with. But it isn’t all doom and gloom for PTs.


A recent article from Gawenda Seminars and Consulting stated that “CPT codes 97112 (neuromuscular reeducation) and 97530 (therapeutic activities) are seeing an increase in their payment rate in 2018 compared to 2017.” However, it is also advised that you never bill a CPT code simply because it has a higher payment rate. It is of the utmost importance that the code you bill accurately reflects the services you or your therapists provided during that session.


We hope you found this article helpful. For more great information about Medicare, head over to the Gawenda Seminars and Consulting website and learn more about the benefits of becoming a Gold Member.

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