New CPT Codes Result in Payment Increases From Medicare
A bit of good news for physical therapists (PTS): thanks to a change in the formula the Centers for Medicare and Medicaid Services (CMS) uses when calculating reimbursement, the new Current Procedural Terminology (CPT) code set for physical therapy evaluation and reevaluation is generating higher payments.
Just how much of an increase PTs are seeing depends on geographic region and whether the payment is for an evaluation or revaluation associated with a Medicare Part B beneficiary (APTA members will be able to identify if they will receive payment increases through an updated online Medicare payment calculator coming to the association's website soon). Some commercial payers may also be affected by the changed formula, depending on how contracts are written.
The altered elements of the formulas are related to 2 areas: the "practice expense" relative value unit (RVU) and the "work" RVU. The practice expense RVU reflects the costs of maintaining a practice, while the work RVU is focused on the relative time and intensity associated with furnishing the service. The formula changes associated with the reevaluation code includes alterations to both RVUs, while the change to the evaluation code formula involves only the practice expense RVU. Overall the increases are consistent with changes advocated by APTA during CMS' development of the 2017 physician fee schedule—the rule that includes the new 3-tiered CPT code set.
According to Carmen Elliott, APTA's vice president of payment and practice management, the increase is definitely a win for PTs—but not something that should cause them to take their eyes off the ball when it comes to payment reform in general, and CPT coding in particular.
"This change is something that PTs definitely should feel good about," Elliott said. "But the fact is, we should expect even bigger changes in the future, and PTs need to remain engaged by learning as much as they can about how to use the new CPT codes properly, because what they do now will shape the future of payment in the long-term."
APTA provides multiple resources to help PTs understand and properly use the new code set, including an upcoming Q-and-A webinar and an online course created in partnership with CEU provider MedBridge. APTA members can also join conversations about the CPT codes and other issues by participating in the association's online community focused on payment reform.