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Payment for Services Provided by Assistants to be Reduced

by • February 11, 2018 • 6 Comments

On February 9, 2018, the United States Senate and House of Representatives passed H.R. 1892 – “Bipartisan Budget Act of 2018” and President Trump signed the bill into law at approximately 8:30am ET on February 9, 2018. The bill passed the Senate by a vote of 71-28 and passed the House of Representatives by a vote of 240-186.

This legislation contains several important implications that will have an impact on outpatient therapy services provided by physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants and speech-language pathologists. This legislation changes the following regarding outpatient therapy services:

  • Annual outpatient therapy cap, exception process, and use of the KX modifier
  • Dollar threshold for the targeted medical review process
  • Payment rates for services provided by a physical therapist assistant or occupational therapy assistant

In this article, I will explain changes to the payment rates for services provided to a Medicare beneficiary receiving outpatient therapy services by a physical therapist assistant (PTA) or an occupational therapy assistant (OTA). To read about the changes to the annual therapy cap, exception process and use of the KX modifier, click HERE. To read about changes to the dollar threshold for targeted medical review, click HERE.

As of the passage of this bill, outpatient therapy services provided to Medicare beneficiaries by a PTA or OTA with dates of service on and after

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6 thoughts on “Payment for Services Provided by Assistants to be Reduced”

  1. Lisa Hoover says:

    HI Rick, just confirming about physical therapy services performed by a PTA is this for outpatient hospital only. We have PTA’s in our practice and we are unable to bill PTA’s in an office setting.

    1. Rick Gawenda says:

      This will be true in all outpatient therapy settings, including private practices.

      1. Marcos Balbo Rios says:

        The payment differential, which was strongly opposed by APTA and other stakeholders, states that PTAs and OTAs will be paid at 85% of the Medicare physician fee schedule beginning in 2022.

        1. Rick Gawenda says:

          Correct, as it stands as of today.

  2. Nikki Swartz says:

    So if a treatment is shared by both a PTA and PT, the entire reimbursement will by 85% of the Medicare allowed?

    1. Rick Gawenda says:

      We will have to wait to see how this processed is “developed” by CMS. We do not know what the words “in whole or in part” mean or what that will look like in 2022 for payment and 2020 and 2021 for the use of the new modifier.

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