APTA 'Deeply Disappointed' By CMS Decision on New Evaluation Codes in Proposed 2017 Fee Schedule
Concerned for its members, the physical therapy profession, and the patients and clients served, APTA expressed "deep disappointment" this week that the Centers for Medicare and Medicaid Services (CMS) failed to adopt different payment values to correspond with 3 levels of physical therapy evaluation that the agency did adopt as new CPT codes in its proposed Medicare physician fee schedule for 2017. The association submitted formal comments to CMS on September 6, continuing its efforts on behalf of members toward the most meaningful and beneficial payment reforms.
APTA strongly urged CMS to revert to the original recommendation from the American Medical Association Relative Update Committee (AMA RUC), which expanded the physical therapy evaluation and reevaluation codes from 1 each to 3 evaluation codes and 1 reevaluation code, including new values for each code. APTA reminded CMS that it conducted extensive analysis and research, and collaborated with many constituents over several years to develop the codes. The association maintains that the codes and the values assigned to them by the AMA RUC are "wholly appropriate to implement … as approved and vetted."
Instead of adopting the entire recommendation, however, the proposed rule includes descriptors for 3 new evaluation codes and 1 new reevaluation code, but values all 3 evaluation codes the same—using the value of the existing single evaluation code. The new evaluation codes reflect 3 levels of patient presentation: low-complexity (97161), moderate-complexity (97162), and high-complexity (97163), and will replace the current 97001 code. The new reevaluation code (97164) also keeps the same value as its predecessor (97002).
If CMS does not include the stratified payment values in the final rule, APTA strongly urged the agency to delay any future payment adjustments that would be based on analysis of claims filed in 2017 under the new codes. The association will work diligently with CMS to analyze billing patterns as providers are educated and become familiar with using the new codes, to prevent a negative impact on future payment. APTA also urged discussion of any viable options to delay implementation of the new codes if the tiered values are not applied to them. (After the release of the proposed rule in July, APTA had written to AMA asking that publication of the codes be delayed to allow additional time for member education. The request was denied.)
As for the education effort, APTA outlined a major campaign to ensure that PTs and PTAs understand the new codes and learn to document appropriately for the 3 evaluation levels, even if there is no difference in their values for 2017. APTA will host a webinar (see below for more information), interactive self-paced learning module, website FAQs, and articles in its publications to support its members in the transition to the new codes. At the same time, APTA says it expects support and coordination from CMS, including getting APTA's input on the agency's own educational resources for physical therapy providers.
APTA also responded to other provisions of the proposed rule, including the following.
- In response to a request from CMS for input on 10 potentially misvalued physical therapy codes, the association confirmed its commitment to working through the process to ensure that the codes are assigned appropriate values. (As part of the process APTA members will be asked to participate in a survey this fall to provide input on how they are using these codes.) APTA requested the opportunity to discuss progress with CMS next year before release of the 2018 proposed fee schedule—to ensure that the voice of the profession is heard during the process and that the association's input is incorporated into the 2018 rule.
- The association asked CMS to use its discretionary authority to permit PTs to perform telehealth services within alternative payment models such as accountable care organizations and the comprehensive care for joint replacement (CJR) bundled payment program, after the agency said it could not override federal law that as of now does not authorize PTs as telehealth practitioners.
- APTA asked CMS to remove physical therapy from the in-office ancillary services exception to the physician self-referral, or Stark, laws. Given that in the proposed fee schedule CMS updates other aspects of the Stark law using broad authority it has to make modifications that "protect against program and patient abuse," APTA strongly recommended applying that same authority to remove physical therapy from the IOAS exception, arguing that this, too, would prevent abuse of the original purpose of the law.
Members can read APTA's comments on the 2017 proposed Medicare physician fee schedule in their entirety on the Medicare Physician Fee Schedule page of the association's website. (Scroll to "APTA Comments.")
Using your clinical judgment as a physical therapist to correctly classify patients' level of evaluation will be critical to collecting data as health care continues its move to value-based care, and to informing future payment for services. APTA's education efforts on the new evaluation codes include a webinar September 22, 2:00 pm–3:30 pm, free to APTA members. Register now at the APTA Learning Center.