CMS Releases Final Rule for 2017

November 2, 2016
Rick Gawenda

The Centers for Medicare and Medicaid Services (CMS) has released the final rule for calendar year 2017 for services paid under the Medicare Physician Fee Schedule. The final rule addresses several important issues relevant to outpatient therapy services including, but not limited to:

  • 2017 therapy cap dollar threshold
  • Therapy cap exceptions process
  • Manual medical review for services above $3700
  • Implementation on new PT and OT evaluation and reevaluation CPT codes
  • Payment of the new PT and OT evaluation and reevaluation CPT codes
  • New PT and OT evaluation and reevaluation codes and their impact on MPPR and therapy cap
  • Documentation changes in CMS Publication 100-02, Chapter 15
  • 2017 conversion factor

Below, I will provide a brief summary of the items listed above.

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  1. If we listened to your most recent presentation on the new OT & PT evaluation codes, are we good to go?

  2. Rick,
    Thank you for this. In regards to the delay in documentation requirements for the new codes, this only applies to patients with Medicare correct? I assume since these codes are new across the board (with the exception of entities not covered by HIPAA) that the documentation requirements would still be in affect for private insurances January 1?

    1. The final rule applies to traditional Medicare and not to other insurance carriers, including Medicare Advantage plans.

  3. Hello,

    When you refer to Documentation requirements are you referencing the new guidelines for the new evaluation codes?

  4. Do you know how much the yearly deductible (that patient’s have to pay before Medicare picks up at 80%) will be for traditional Medicare? It was $166 in 2016. I thought it normally came out about the same time as the updated therapy cap amounts.

  5. With the new codes, will outcome measures be required at all evals/re-evals for all HIPPA covered entities?

    1. Outcome tools are not required, but will help in supporting the level of evaluation you report.