Congress Passes Legislation Reducing 9% Payment Reduction

December 22, 2020
 / 
Rick Gawenda
 / 

On December 21, 2020, the United States Senate and United States House of Representatives passed legislation that will have a financial impact on outpatient physical, occupational and speech therapy services thru December 31, 2023. President Trump signed the legislation into law on December 27, 2020. In this article, I will provide information on the following topics:

  1. Conversion factor change for calendar year 2021 that will impact payment for outpatient physical, occupational and speech therapy services under the Medicare Physician Fee Schedule.
  2. Extension of temporary suspension of Medicare sequestration
  3. Extension of the Work Geographic Index Floor minimum of 1.0
  4. Places a moratorium on the payment for G2211
  5. How does G2211 impact payment for outpatient therapy services?
  6. In simple terms, what is the expected payment adjustment for outpatient therapy services in 2021 compared to 2020?

Let’s Begin

Medicare Physician Fee Schedule (MPFS) and the Conversion Factor

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Extension of Temporary Suspension of Medicare Sequestration

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Extension of the Work Geographic Index Floor Minimum of 1.0

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Places a Moratorium on the Payment for G2211

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How Does G2211 Impact Payment for Outpatient Therapy Services?

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In simple terms, what is the expected payment adjustment for outpatient therapy services in 2021 compared to 2020?

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  1. thanks Rick. So if they add back the savings on not reimbursing CPT code 2211 and this increases the reimbursement by 3.75%, if they vote to put a 2 year moratorium on the 9% cuts would that mean we will see an increase of 3.75% in cy 2021?

    1. Read the last question and answer to see the final reduction for 2021. There is no 2-year vote. This is the legislation that was passed.

  2. So in layman’s terms, we are getting a 3.6% cut in our OVERALL outpatient PT reimbursements?

  3. Since CORF’s and ORF’s are paid from the Part B Physician fee schedule these Medicare cuts will apply for CORF’s and ORF’s billing PT/OT/ST in 2021 correct?

  4. Thru March 31, 2021 we would see an additional 2% due to the suspension of the sequestration.

  5. Can you tell me where I can find information regarding G2211 in relation to PT/OT as to how/when to bill? Thank you, as always!