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  • Proposed Medicare Fee Schedule Maintains—and Sometimes Increases—Payment for Codes Related to Physical Therapy

    No cuts. And even a few increases.

    That's the major takeaway from the proposed Medicare 2018 physician fee schedule released by the US Centers for Medicare and Medicaid Services (CMS). It's a plan that settles questions about potentially "misvalued" current procedural terminology (CPT) codes by generally accepting work relative value units (RVUs) that had been proposed by an American Medical Association (AMA) advisory committee that worked closely with APTA.

    Under the proposed fee schedule, 13 of 19 CPT codes frequently used by physical therapists (PTs) will retain their 2017 RVUs, with the remaining 6 seeing slight increases. Additionally, RVUs for 2 codes associated with the management and training of patients with orthotics or prosthetics were increased, and a new code was added (977X1, intended for use on a "subsequent encounter" or different date of service from the initial encounter).

    The codes slated for increases are:

    • 97112: Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception, from .45 to .50
    • 97113: Aquatic therapy with therapeutic exercise, from .44 to .48
    • 97116: Gait training, from .40 to .45
    • 97533: Sensory integrative techniques, from .44 to .48
    • 97537: Community/work reintegration, from .45 to .48
    • 97542: Wheelchair management, from .45 to .48

    CMS also proposes leaving practice expense inputs untouched for the 19 major codes and the CPT codes related to orthotics and prosthetics.

    The proposed rule is a significant win for PTs, whose most-often used CPT codes were under scrutiny by CMS as being potentially "misvalued"—a term that usually means CMS thinks it's paying out too much. APTA made the multiyear code analysis process a top priority and worked closely with AMA's Health Care Professional Advisory Committee to develop recommendations to CMS. Those efforts included an extensive survey of PTs administered last fall.

    "The proposed physician fee schedule is an affirmation of the value of physical therapy," said Carmen Elliott, MD, APTA's vice president of payment and practice management. "We are especially grateful for the level of participation we received from APTA members in thoughtfully filling out surveys in 2016. The data AMA received were key in the development of strong recommendations with solid backing in practice."

    Other highlights of the proposed 2018 fee schedule:

    • CMS will debut "patient relationship modifiers," a set of codes intended to describe the role of the provider to the patient, such as "continuous," "episodic," "broad" and "focused." PTs will not be required to report these data in 2018 but could be required to by 2019.
    • The Medicare Diabetes Prevention Program (MDPP) expanded model would include "policies to further define the set of MDPP services, beneficiary eligibility criteria, and supplier eligibility and enrollment criteria," according to a CMS fact sheet. CMS also asks for comments on MDPP services and payment, supplier enrollment and administrative burden, and program integrity safeguards.
    • CMS continues its request for comments on how the overall Medicare system could be improved—input APTA already has provided in comments to other proposed rules.

    CMS has published a fact sheet on the proposed rule. APTA will submit comments on the proposed rule by the September 11 deadline, and will publish a PT-focused fact sheet when CMS issues a final rule sometime in late October or early November.


    • Thanks for all the hard work. The Medicare population is truly grateful for this. They deserve nothing but the best & we should treat them with the utmost respect.

      Posted by Marc Gregory Guillen on 7/19/2017 4:36 PM

    • That is enough for the 8 minutes and 15 minutes time limit for each modalities or procedure to get payment from insuranceS and Medicare . Doctor see the patient a minute or 5 minutes does not put hands on the patient , get full visit charge . Let's leave it the therapist how much patients needs time for procedure and treatment . let's work on Medicare direct access for 8 -10 visits prior to they see doctor , cuts MRI or other expensive test expense narcotic expensive pain pills . All manual test has to be done and listen the patient prior to send them to MRI or other test . I believe this will save time and money for or patients and CMS systems . I see private patients they are better in 3-6 visits most of it . if they are not we send them to best practitioner or doctor . if they are surgical we refer them out anyway.

      Posted by Yalcin Ekren on 7/25/2017 11:38 AM

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