CMS is proposing to increase the group or virtual group reporting threshold from at least
On July 31, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for Fiscal Year (FY) 2020 for Inpatient Rehabilitation Facilities (IRFs). CMS projects that FY 2020 payments to IRF’s will increase by 2.5% compared to FY 2019. In the final rule, highlights of issues addressed by CMS include:
- Case-Mix Group Revisions (using FY 2017 and FY 2018 data)
- Rebase and Revise the IRF Market Basket
- Clarification of “Rehabilitation Physician”
- Ensuring Quality
- IRF Quality Reporting Program (QRP)
To read a Fact Sheet of the final rule, click HERE. To access the Final Rule, click HERE.
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On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for calendar year (CY) 2020 for services paid under the Medicare Physician Fee Schedule (MPFS). This proposed rule does impact providers of outpatient physical, occupational and speech therapy services in all outpatient therapy settings that does include private practices, hospital outpatient departments (including Medicare beneficiaries under Observation status and in the Emergency Department and do not get admitted to the hospital), skilled nursing facilities, rehabilitation agencies, comprehensive outpatient rehabilitation facilities and home health agencies providing outpatient therapy in a Medicare beneficiaries home.
Highlights of the proposed rule include:
- Proposing to revise the regulations at §§ 410.59 and 410.60 discussing the annual therapy threshold, use of the KX modifier, and the targeted medical review threshold
- CQ/CO Modifiers to be appended to CPT codes for services provided in whole or in part by a PTA or OTA
- To add a requirement that the treatment notes explain, via a short phrase or statement, the application or non-application of the CQ/CO modifier for each service furnished that day
- PTA and OTA Payment Changes in 2022
- New CPT codes for trigger point dry needling
- New Biofeedback CPT codes
- New Health and Behavioral Assessment and Intervention CPT codes
- Discussing the 2 new Cognitive Function Intervention CPT codes
- Work relative value unit (RVU) for CPT codes 97597 and 97598
- Proposing an Active Status for CPT codes 97607 and 97608
- Proposing a work RVU of 0.40 for CPT code 97610
- Online Digital Evaluation Service HCPCS Level II Codes
- 2020 Medicare Physician Fee Schedule Conversion Factor
- 2020 MIPS Program
Revising Regulations at §§ 410.59 and 410.60
CQ and CO Modifiers
de minimis Standard for CQ and CO Modifiers
Documentation Requirements to Support Use of or Non-use of CQ/CO Modifiers
PTA and OTA Payment Changes in 2022
New CPT Codes for Trigger Point Dry Needling
Biofeedback CPT codes
New Health and Behavioral Assessment and Intervention CPT Codes
Cognitive Function Intervention CPT Codes
CPT Codes 97597 and 97598
CPT Codes 97607 and 97608
CPT Code 97610
Online Digital Evaluation Service
When you see the letter “X” in a new CPT code, this “X” will be replaced by the actual number that is in the CPT code once the American Medical Association (AMA) releases the 2020 CPT codes in early September. The same is true with the letters “NPP” in the 3 new HCPCS codes described above. These letters will be replaced by numbers once the AMA releases the 2020 CPT codes in early September.
2020 Medicare Physician Fee Schedule Conversion Factor
I hope you found this article informative. To access the proposed rule, click
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UnitedHealthcare Community Plan has announced they will implement prior authorization for outpatient physical, occupational and speech therapy services in select states beginning as early with dates of service on and after August 1, 2019. In addition, UnitedHealthcare Community Plan has announced they will be conducting site of service medical necessity reviews for all speech, occupational and physical therapy services in select states.
Effective with dates of service on and after August 1, 2019, the following states will be required to obtain prior authorization before implementing outpatient physical, occupational and/or speech therapy services: