The Centers for Medicare and Medicaid Services (CMS) has issued a new rule for the Outpatient Prospective Payment System (OPPS) that will create 29 comprehensive Ambulatory Payment Classifications (APCs) to handle payment for the most costly device-dependent services, require direct supervision for a range of outpatient services in critical access hospitals (CAHs), and increase the payment rates under the OPPS by 1.7 %. The new rule will be effective January 1, 2014; however, CMS will delay implementation and final configuration of the new 29 comprehensive APCs until 2015.
The comprehensive APCs would treat all individually reported codes as components of a comprehensive service, resulting in a single prospective payment based on the cost of all individually reported codes. CMS will make a single payment for the comprehensive service based on all charges on the claim, and charges for services that cannot be covered separately by Medicare Part B or that are not payable under the OPPS will not be reimbursed. Although physical therapy services are typically paid separately under Medicare Part B, some therapy services would be considered part of the comprehensive service based on several factors. In general, physical therapy services that occur in the perioperative period would be paid under the comprehensive APC payment.
The new rule also establishes a direct supervision requirement for outpatient therapeutic services in CAHs, a change that CMS believes will ensure quality and safety. Additionally, the rule reiterates the requirement in the physician fee schedule that the therapy cap must be applied to CAHs.
APTA submitted comments regarding the proposed rule and will continue to monitor the effect that these provisions will have on physical therapy. APTA will post a detailed summary of the final rule shortly.
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