The Centers for Medicare and Medicaid Services (CMS) reimburses for outpatient therapy services under Medicare Part B utilizing the Medicare Physician Fee Schedule (MPFS) in all settings except for critical access hospitals (CAH’s). CAH’s are reimbursed on a cost basis. CMS has developed a fee schedule that encompasses work expenses, practice expenses, and malpractice expenses for each modality and procedure (CPT code) that therapists provide to their Medicare patients. The amount that CMS reimburses is dependent upon the area in the country that you provide the outpatient therapy services. Currently, there are 91 localities in the encompassing United States, Puerto Rico, and Guam.
Please follow the link below to obtain the reimbursement information you are seeking. Click “start” on the first page. Choose if you want pricing information on a single CPT code, list of CPT codes, or range of CPT codes then click “next.” Under “Select Carrier Option” choose “Specific Locality.” And then click “next.” Complete the CPT code(s) or range of CPT codes you want pricing information on. For the drop down box for “modifiers,” select “all modifiers.” For locality, choose your specific locality where you do business. Keep in mind that all settings are reimbursed the non-facility rate for outpatient therapy services.