Please note that this article contains information that is only relevant to our American clinics.
Earlier this month, the Center for Medicare and Medicaid (CMS) released their final rule for the 2017 calendar year. This new rule touches upon several important topics related to services paid under the Medicare Physician Fee Schedule, as well as a few important issues relevant to outpatient therapy services. In this article, we will be providing a brief rundown on some, but not all, of these changes.
New Therapy Cap
On January 1, 2017, the physical therapy and speech-language cap will be changed to $1,980.00. There’s also a separate $1,980 available to patients in need of occupational therapy treatment.
Therapy Cap Exceptions Process
The therapy cap exception use of the KX modifier remains in effect for all dates of service in 2017. Rick Gawenda of Gawenda Seminars and Consulting stated that “If a Medicare beneficiary exceeds the 2017 therapy cap threshold of $1,980 and the therapist determines therapy is still medically necessary and requires the unique skills of a therapist, the therapist would give the okay to use the KX modifier for services provided above the therapy cap dollar threshold.”
Manual Medical Review
In accordance with the passage of the CHIP Reauthorization Act of 2015, the CMS doesn’t need to review all claims that exceed the $3,700 threshold. However, they will be choosing the therapists and facilities that they review more carefully. They’ll be focusing on therapy providers with a higher claims denial rate in comparison to their peers.
New Evaluation Codes for PTs and OTs
There are a total of 6 new evaluation codes (CPT codes) for PTs and OTs. They are as follows:
Furthermore, Payment for re-evaluation CPT codes for PTs will be the same across the board.
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