Medicare Estimated Payments for Outpatient Therapy in 2023

January 2, 2023
Rick Gawenda

On November 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2023 final rule for services reimbursed under the Medicare Physician Fee Schedule (MPFS). Click HERE to read my summary on the final rule that will impact outpatient physical, occupational and speech therapy services in 2023.

On December 22, 2022 and December 23, 2022, the United States Senate and United States House of Representatives, respectively, passed the Consolidated Appropriations Act, 2023. Included in this legislation was Congress providing additional funding to the Medicare program to help offset some, but not all, of the 4.47% reduction in the 2023 Conversion Factor (CF) compared to the 2022 CF.

In this article, I will provide my members with the estimated payment amounts for calendar year 2023 for the more common CPT codes billed in outpatient physical, occupational and speech therapy compared to the 2022 payment rate for each CPT code. For my examples, I used the national payment averages for each CPT code. Based on the location of your clinic/organization, your payment may be higher or lower than the national average.

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  1. Hi Rick,

    With a code pattern of 97140 x 1, 97110 x 1 and 97530 x 1 = $94.88, what reduction would I be hit with with sequestration, MPPR for a PT and then for a PTA on tradtional medicare?

    Thank you.