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  • CMS Releases Proposed 2013 Physician Fee Schedule Rule

    Today, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2013 Medicare physician fee schedule rule that updates 2013 payment amounts and revises other payment policies. Excluding the 31% projected sustainable growth rate payment cut, the aggregate impact on payment of changes in the rule is a positive 3% for outpatient physical therapy services. Additional proposed policies that will impact physical therapists include implementation of new functional status codes for reporting therapy services, updates to the Physician Quality Reporting System (PQRS) program, and initiatives to promote care coordination.

    As required by the Middle Class Tax Relief Jobs Creation Act of 2012, CMS proposes to implement a claims-based data collection process to gather data about patient function for patients receiving outpatient physical, occupational, and speech therapy services. Therapists would be required to report new codes and modifiers on the claim form that reflect a patient's functional limitations and goals at initial evaluation, periodically throughout care, and at discharge. This data is for informational purposes and is not proposed to be linked to reimbursement. This reporting system is proposed to be implemented on January 1, 2013. Claims will be processed during the first 6 months until July 1, 2013, regardless of the inclusion of the functional limitation codes. Beginning July 1, 2013, all claims must include functional limitation codes to be paid by Medicare.

    CMS proposes to retain the 12-month calendar year reporting period for the PQRS program in 2013 and beyond. The incentive payment for 2013 will remain 0.5%. The 2013 reporting period data will be used to inform both the 2013 incentive payment (0.5%) and the 2015 payment adjustment (-1.5%). Successful reporting requirements for the program are proposed to remain as they were in 2012 requiring that participants report a minimum of 3 individual measures or 1 group measure via claims based reporting on 50% or more of all eligible Medicare patients, or report a minimum of 3 individual measures or 1 group measure via registry reporting on 80% or more of all eligible Medicare patients. 

    CMS proposes to establish new procedure codes that would allow reporting and payment for additional resources required for a physician and nonphysician practitioner to coordinate a patient's care outside a face-to-face patient encounter in the 30 days following discharge to the community from an inpatient hospital stay and skilled nursing facility stay.

    The public will have until September 4 to submit comments in response to this rule. On behalf of its members, APTA will submit comments in response to the rule. After reviewing public comments, CMS will publish a final rule on or about November 1, which will become effective for services furnished during calendar year 2013. APTA will provide a more detailed summary of the rule in the upcoming week.


    • Great, more codes and modifiers. It was already a challenge setting up codes for the fee reductions this year on all but the code with the highest PE. It's still a challenge. Is there room for more modifiers? We already bill 59GPKX on many codes.

      Posted by Debbe on 7/6/2012 11:03 PM

    • Wondering if the functional limitation codes will coincide with FIM levels, or if it will be a new set of codes. We have found that the current FIMs are not sensitive enough to capture progress in the neurological population. I have PT/OT/ST therapists in our hospital-based Neuro practice. This is complex. I hope there are some big thinkers on this team!

      Posted by Mary Anne Kramer-Urner on 7/7/2012 12:35 PM

    • I am wondering if this functional limitation code will be base on ICF or will new codes be formed for these functional limitations. Thanks

      Posted by Raifu Olorunfemi on 7/7/2012 4:03 PM

    • Great, more reporting. Will they be giving us a heads up on what we are measuring/reporting on and how we will do that?

      Posted by Jan on 7/8/2012 6:18 PM

    • After the 31% reduction from projected sustainable growth rate payment cut, you really care about modifiers and new codes? If the payment cut does not happen, then we should do all possible to reduce not add onto our non-clinical responsibilities.

      Posted by Barry Broman on 7/11/2012 10:40 AM

    • i was looking for the new policy that effects how much pt, ot, and st that a person can receive that will be covered by medicare. its called "manual..." something? please help

      Posted by witney martinez on 9/22/2012 10:19 AM

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