Now that the dust is starting to settle post October 1st Patient-Driven Payment Model transition, it is time take heed to provisions in the 2020 Physician’s Fee Schedule (PFS) final rule released in November. There are items of high importance to therapy professionals and those that benefit from our services. Now is the time to act.

  1. Starting on January 1st, 2020 the Centers for Medicare and Medicaid Services (CMS) will begin collecting modifiers to indicate when outpatient physical or occupational therapy services are provided “in whole or part” by a PTA or OTA to a patient with Medicare Part B insurance. This is preparation for the next item.
  2. When more than 10% of PT or OT services are provided by an assistant, the services will be reimbursed at 85% of the full fee schedule. This reduction in assistant reimbursement is schedule for claims billed on or after January 1st, 2022. This applies to skilled nursing, rehab agencies, hospital outpatient, and private practice.
  3. In order to increase payments to the physician evaluation and management codes, CMS is proposing an estimated 8% reduction in Medicare Part B reimbursement for therapy services in order to maintain budget neutrality. This is set for therapy services provided on or after January 1, 2021.

The therapy associations and other stakeholders are already advocating on our behalf to ensure our much-needed services are not devalued by these cuts thus putting patients at risk. Make your voice heard by contacting your legislators now. Share with everyone you know and ask that they do the same. Let’s make our voices heard!

To find your legislators: https://www.govtrack.us/congress/members

APTA feature that sends letter directly to your legislators: https://www.votervoice.net/APTA/Campaigns/69563/Respond

Melissa Ward
VP Clinical and Regulatory Affairs