On November 1st, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule. As you know, this summer PPS and APTA strongly encouraged our members to submit comments to CMS explaining how the proposed rule would harm their patients and their practices. As a result, CMS received 14,000 comments regarding physical therapy issues in the proposed rule.

When it came to how CMS was going to regulate the legally binding 15% reduction of payment for care provided “in whole or in part” by a therapy assistant, our feedback worked!

The final rule states that:

1. Only the minutes that the PTA/OTA spends independent of the therapist will require the CQ/CO modifier and count towards the 10% de minimis standard.  This means care furnished by a therapist and therapy assistant together will not be counted as PTA time.

2. CMS will allow the separate reporting—on two different claim lines—of the number of 15-minute units of a code to which the therapy assistant modifiers do apply, and the number of 15-minute units of a code to which the therapy assistant modifiers do not apply.  This means that when the same service/code is furnished separately by the PT and PTA, CMS will apply the de minimis standard only to the service/code with the CQ/CO modifier—not on the combined PT and PTA time of the service.

3. There will be no requirement of a narrative phrases in the medical record that says why a PTA was or was not used.  CMS agreed it was duplicative.

However, the MPFS final rule was not all good news. Unfortunately, our concerns with respect to the 8% cut were ignored.

In the proposed rule CMS proposed cuts to many specialties in order to offset the increases they were proposing for E/M codes. In the Final Rule, they made no changes (for any specialty) and decided to finalize their proposal which is a cut of 4% for work and 3% for practice expense RVUs for physical and occupational therapy. After rounding, this ends up an 8% cut in 2021.  While thousands of PTs and other stakeholders pushed back against these proposed cuts, CMS was unmoved and provided no explanation or rationale for its decision. 

Furthermore, the final rule also notes that the cuts are “for illustrative purposes only” so it remains unclear when the Agency will undertake an in-depth analysis of the issue.  PPS will be working closely with APTA over the next year ensure that CMS understands the impact these cuts would have upon patients and the profession, with the goal of CMS walking back the magnitude of the payment reduction.

Check out APTA’s PT in Motion article for additional information.

Please click here to login or create an account to leave a comment


Recent Posts