CMS Estimate Payment for Outpatient Therapy in 2023

July 12, 2022
Rick Gawenda

On July 7, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 proposed rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Click HERE to read my summary on the proposals that will impact outpatient physical, occupational and speech therapy services. Comments are due by 5:00pm on September 6, 2022. In this article, I will provide my members with the estimated payment for calendar year 2023 for the more common CPT codes billed in outpatient therapy compared to the 2022 payment rate for each CPT code. For my examples, I used Detroit, Michigan as the payment locality.

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  1. Where can I go to find the complete list of CPT codes for PT/OT/SLP and the cost changes projected for CY 2023?

  2. For SLP, do you happen to know the estimated payments for codes: 97129 and 97130, 92612?
    Thank you, Jo

    1. When the final rule is released in early November, I will have an extended list of CPT codes with the 2023 payment values. We also hope Congress intervenes prior to December 31, 2022 to mitigate the average 4.4% payment reduction.

  3. Can you review the system of reduction after the first code of Medicare? For instance, if someone bills 2 units of 97530, 1 unit of 97140 and one of 97150 what is the math on how the codes after the top code is reduced?