12/1/2020: The Centers for Medicare and Medicaid Services (CMS) issued the CY 2021 Medicare Physician Fee Schedule (PFS) Final Rule, which will take effect on January 1, 2021. This included:
- Updated Payment Policies
- Payment Rates
- Telehealth Policies
- Quality Provisions
This Final Rule reflects E/M policies that will result in significant cuts to many specialty providers, including codes billed by therapy.
- 9% cut to part B physical and occupational therapy services beginning January 1, 2021
- 6% cut to part B Speech therapy services beginning January 1, 2021
WHAT DOES THIS MEAN?
As a biller of Medicare Part B Services, you will see a 9% PT/OT and a 6% SLP reduction in what you are currently paid per code completed.
Therapy CPT codes 97161-97168; CPT codes 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521-92524, 92507 are added as Category 3 code which means the services are NOT added permanently to the telehealth code list but instead may be delivered via telehealth through the Public Health Emergency (PHE) and through the calendar year in which the PHE ends.
WHAT DOES THIS MEAN FOR THERAPY?
Until the PHE is over, PT/OT/SLP is temporarily allowed to continue with telehealth services for the specific codes listed above. Therapy is a Category 3 and at this time will not be able to continue after the PHE. Virtual onsite evaluations can continue post PHE. CMS is reiterating in this Final Rule that telehealth rules do not apply when the beneficiary and the practitioner are in the same location even if audio/video technology assists in furnishing a service.
In this Final Rule, CMS is finalizing its proposal to make permanent its Part B policy for maintenance therapy services that was adopted on an interim basis for the PHE in the May 1st COVID-19 IFC that grants physical therapists (PTs) and occupational therapists (OTs) the discretion to delegate the performance of maintenance therapy services, as clinically appropriate, to a therapy assistant – a physical therapist assistant (PTA) or an occupational therapy assistant (OTA).
WHAT DOES THIS MEAN?
Physical therapy assistants and occupational therapy assistants may follow the plan of care established by a physical therapist/occupational therapist and treat residents for maintenance therapy.
Please email Ryan Jones for additional information: [email protected]