The days of a physical therapist assistant or occupational therapy assistant not being able to treat TRICARE beneficiaries under the supervision of a therapist may soon be over. The House and Senate Armed Services Committees reached an agreement on the National Defense Authorization Act (NDAA) that includes language to direct the Department of Defense (DOD)
On November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This final rule impacts providers and suppliers of outpatient physical and occupational therapy services as well as speech-language pathology services. This would include outpatient therapy services provided in the following settings:
- Private Practice
- Skilled Nursing Facility Part B Therapy
- Comprehensive Outpatient Rehabilitation Facility
- Rehabilitation Agency
- Home Health Doing Part B in the Home
- Hospital Outpatient Departments
Highlights of the final rule include:
- 2018 annual therapy cap dollar threshold and manual medical review process
- New and revised CPT codes for orthotic and prosthetic management and training
- New CPT code for cognitive function intervention that CMS will not pay for
- New HCPCS Level II code for cognitive skills that CMS will pay for
- 2018 conversion factor used to determine payment for each CPT code
- Changes to work RVU’s and practice expense RVU’s for therapy CPT codes
A question I often receive regarding physician orders is how old can a physician order/referral for outpatient therapy be? Must therapy begin within 30 days, 60 days, 90 days, etc. of the order/referral being signed and dated by the referring physician?
For Medicare Part B therapy services, the Centers for Medicare and Medicaid Services (CMS) does
There is a local orthopedist who owns 7-8 PT practices in my area. When we perform an Initial Evaluation on one of his Medicare patients, he refuses to sign off on our plan of care (POC) even though we have his prescription. We will follow up multiple times with his front desk staff and even have the patients contact the referring MD office. The response is that these Medicare patients must be seen at his clinic/PT office. Is that correct?
On October 26, 2017, lawmakers from the House Energy and Commerce Committee, the House Ways and Means Committee, and the Senate Finance Committee announced a bipartisan agreement to end the therapy cap. This is just a proposal and must still be approved by the House of Representatives and the Senate. To access the proposal, sign in to your account or become a Gold Member!
The proposal would do the following regarding the annual outpatient therapy cap and for claims exceeding $3700 in a calendar year: