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  • 2016 Physician Fee Schedule Includes Modest Increase, Continues Exploration of Misvalued Codes

    The final rule for the 2016 physician fee schedule from the Centers for Medicare and Medicaid Services (CMS) includes a slight overall payment increase, the expansion of several quality measures, and continued examination of potentially "misvalued" current procedural terminology (CPT) codes, including 10 related to physical therapy.

    APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary of its provisions in the coming weeks. In the meantime, here are some features of the new rule that affect physical therapists:

    • Estimated payment rate increase of .5%. This amounts to a conversion factor of $35.83, which reflects a 0.5% increase and budget neutrality adjustment of 0.7777 called for under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
    • Therapy cap increase to $1960. (The therapy cap exceptions process was extended through December 31, 2017, under MACRA.)
    • Ten physical therapy CPT codes included in a CMS list of 103 codes that it believes are misvalued and should be adjusted down. CMS is waiting on information from the American Medical Association's Relative Update Committee (RUC) before deciding which, if any, codes will be removed from this list.
    • PQRS will contain 281 measures; the GPRO web interface will include 18 measures.
    • Group practices will be able to report quality measures via the Qualified Clinical Data Registry.
    • Continued phase-in of public reporting to Physician Compare.

    Other provisions addressed in the new rule affect the Merit-Based Incentive Program and physician self-referral. These changes will also be addressed in the upcoming APTA summary document.

    Stay tuned: in addition to the summary of the 2016 fee schedule rule, APTA will post an updated Medicare fee schedule calculator that will enable PTs to estimate CPT code-based payment for 2016.


    • How about some more details so the info can be reviewed such as which CPT codes, when and how can we report, when for both? Thanks

      Posted by Keith Glasser on 11/4/2015 7:16 PM

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