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The U.S. Centers for Medicare & Medicaid Services has released the proposed 2024 Medicare Part B Physician Fee Schedule, and, as always, it's a mixed bag of good and not-so-good news.

Unfortunately, as in previous years, payment cuts are a part of the proposal. This time around, however, other upsides are more prevalent than they've been in a while, with many of the welcome changes directly related to APTA advocacy efforts.

(Prefer a listening experience? Check out this podcast interview with APTA staff experts that focuses on highlights of the proposed fee schedule.)

In a statement on the proposed fee schedule, APTA President Roger Herr, PT, MPA, characterizes the additional cuts — the fourth round of cuts in as many years — as "unacceptable" but notes that several provisions of the rule will have a positive impact on PTs, PTAs, and patients. Herr's statement also presses lawmakers to make wide-ranging reforms to the fee schedule system in line with policy principles developed by APTA, the American Occupational Therapy Association, and the American Speech-Language-Hearing Association.

Here's a quick rundown of some of what's in the proposed rule. Check out part 2 of our fee schedule takeaways series for information on proposed changes to the Quality Payment Program and the Merit-based Incentive Payment System.

Another conversion factor cut — but not as severe as anticipated.
CMS proposes another decrease in the conversion factor, one of the elements used in calculating final payment amounts for various codes. This time around, the conversion factor is $32.7476, a 3.3% decrease from the $33.8872 conversion factor adopted in 2023. The change is far-reaching, affecting more than 27 specialties including physical therapy.

While still damaging, the cut was less than the anticipated 4.2% cut, which would've been similar to last year's reduction. The reason, according to CMS, is that it reconsidered utilization estimates of a particular evaluation and management add-on code, which in turn allowed the agency to back off on cuts to the conversion factor. CMS must make the reductions to the conversion factor to offset the evaluation and management increases in order to maintain budget neutrality.

An exploration of potentially misvalued codes, with the possibility for increases.
In early 2023, APTA made the case to CMS that several codes frequently used by PTs are subject to a kind of double jeopardy that unfairly cut values. The association argued that, first, 19 codes that include therapeutic exercises, neuromuscular reeducation, gait training, and therapeutic activities were undervalued by the AMA Relative Value Scale Update Committee that sets payment rates typically adopted by CMS. Second, these codes simultaneously were subject to reductions associated with the Multiple Procedure Payment Reduction system. The association asserted that both devaluations are being made for the same ostensible reason — to account for a duplicative practice expense when multiple codes are used on the same day. APTA told CMS that discounting codes twice for the same rationale didn't make sense.

CMS listened. In the proposed rule, CMS directs the AMA committee to re-review its earlier value recommendations. The list of affected codes can be found on Page 66 of the proposed rule. If this reconsideration is adopted in the final rule, APTA believes that the values of many of the codes on the list will be increased.

Consideration of moving to general supervision for PTAs in private practice, extension of virtual supervision through 2024, and relaxed requirements around PTAs doing RTM.
Could CMS be seeing the light when it comes to supervision of PTAs in private practice settings? In response to advocacy from APTA and other groups, the agency is asking for public comment on the possibility of moving away from direct supervision of PTAs and occupational therapy assistants in private practice — currently the only setting under Medicare in which 100% face-to-face supervision is required — in favor of general supervision. APTA and the American Occupational Therapy Association have made the shift to general supervision a top-level advocacy priority that even includes potential federal legislation.

In the proposed rule, CMS asks for feedback on safety concerns, potential limits on the types of services provided under general supervision, patient visits by the supervising PT or OT, and possible effects on hiring. APTA will provide detailed comments on these issues by the Sept. 11 deadline.

In more good news, the proposed rule also extends virtual supervision of PTAs and OTAs through the end of 2024. That flexibility was set to expire at the end of 2023, in conjunction with the end of the pandemic-related public health emergency.

The proposed rule also includes a potential win for decreased administrative burden around remote therapeutic monitoring, or RTM, when conducted by PTAs: CMS proposes a general supervision-only requirement for PTAs performing RTM, regardless of setting. That change would take effect in 2024.

Adoption of new caregiver training codes.
In another win for APTA, CMS proposes the adoption of codes that would allow PTs, OTs, speech-language pathologists, and other providers to bill for providing training to caregivers of patients living with a functional deficit. The addition to the fee schedule is CMS' acknowledgement of the advocacy gains made by APTA, AOTA, and ASHA when the groups successfully lobbied the AMA Current Procedural Terminology Editorial Panel to accept the codes for use beginning in 2024.

Confirmation that telehealth can continue through 2024.
In the proposed rule, CMS follows through on its assurances that it would adopt a Dec. 31, 2024, date for the end of telehealth allowances for PTs and PTAs under Medicare. The end date brings Medicare policy in line with requirements of the Consolidated Appropriations Act of 2023. In addition, the fee schedule avoids an earlier CMS error — the exclusion of institutional settings from the list of settings allowed to provide PT services via telehealth. CMS corrected that mistake after it was pointed out by APTA earlier this year, and extended telehealth to all outpatient settings through 2023. That allowance continues through the end of 2024 in the proposed rule.

The larger issue — including PTs and PTAs among providers permanently empowered to provide telehealth services under Medicare — is the target of another significant advocacy push from APTA and other supporters. CMS says that it doesn't have the statutory authority to change its list of approved telehealth providers to include PTs. Bipartisan legislation has been introduced in the U.S. House of Representatives that would do exactly that and more. Until that happens, the agency says it will avoid making telehealth codes for PT services permanent.

Keep up with APTA's advocacy efforts: Sign up for the APTA Advocacy Network, a free, members-only service that sends you special legislative updates and action alerts so you're up to speed and ready to act.

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