For those of you that provide outpatient therapy services to Medicare beneficiaries, many of you will see a decrease in your payments in 2018 compared to 2017 due to a reduction in payment of the most commonly billed CPT codes to the Medicare program. However, several CPT codes that perhaps you should have been billing all these years will see an increase in their payment rate in 2018 compared to 2017.
This change in payment is due to changes in the work relative value unit (RVU) and practice expense (PE) RVU of the CPT codes. The work RVU takes into account the relative level of time, skill, training, and intensity to provide the service. The PE RVU takes into account the cost of running a practice such as mortgage or rent payment, office supplies, equipment and non-physician staff costs.
I won’t bore you with the details on the work and PE relative value units (RVUs) of the most commonly billed CPT codes under a physical therapy and/or occupational therapy plan of care for 2018 compared to 2017. What I will provide you with are the payment changes in the most commonly billed CPT codes under a physical therapy and/or occupational therapy plan of care for 2018 compared to 2017. Codes discussed in this article will include, but are not limited to, mechanical traction, iontophoresis, therapeutic exercise, neuromuscular reeducation, aquatic therapy, massage, manual therapy, therapeutic activities, wheelchair management, orthotic management and training and prosthetic management and training.
Payment for each CPT code will vary dependent on your payment locality due to the geographic price cost index (GPCI). The GPCI is used by the Medicare program to adjust payment rates to take into account regional and practice-specific factors.
In calendar year 2018, there are approximately 112 different payment localities. For the purpose of this article, I will use Los Angeles county to show the pay differences in 2018 compared to 2017 on the most commonly billed CPT code under a Medicare Part B physical and/or occupational therapy plan of care.
CPT Code 2018 Payment Rate 2017 Payment Rate Change
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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.