Information and resources on Medicare coding and billing. If you have questions about this information, contact firstname.lastname@example.org.
2019 and Beyond
Patient-Driven Groupings Model
As part of overall efforts to move Medicare payment away from fee for service and toward a structure that holds providers accountable for patient outcomes and costs, the Centers for Medicare and Medicaid Services (CMS) has made significant changes to the home health and skilled nursing facility (SNF) payment systems. The SNF Patient-Driven Payment Model (PDPM) began October 1 (the start of fiscal year 2020), and the Home Health Patient-Driven Groupings Model (PDGM) begins January 1, 2020. Learn more about these new payment models.
PTs practicing in postacute care are integral to improving the quality of care provided to patients while reducing overall costs. This is particularly true under new value-based payment initiatives such as bundled payment models, accountable care organizations, and patient-centered medical homes. Changes to the payment systems for IRFs, SNFs, LTCHs, and HHAs are having significant impact on the profession.
As the Centers for Medicare and Medicaid Services is still exploring whether and how to incorporate striated payment into the tiered CPT codes for the 3 levels of physical therapy evaluation, it's important to be familiar with the codes and to use them accurately.
Quick Guide: Using the PTA Modifier (.pdf) - 12/11/19
This APTA guide will help you identify when you must apply the CQ modifier for outpatient services provided at least in part by a physical therapist assistant.
Insider Intel Recorded Webinar
FREE to APTA Members
Discussion Topics to Include: CY 2018 home health final rule, Quality Payment Program (QPP), Merit-Based Incentive Payment Program (MIPS), Postacute care, physician fee schedule, and Medicare Therapy Cap.