Many employees of hospitals do not understand how the Centers for Medicare and Medicaid Services (CMS) reimburse for outpatient physical, occupational, and speech therapy services provided by a hospital outpatient therapy department. Does CMS reimburse for these services under the Medicare Physician Fee Schedule (MPFS) or the Outpatient Prospective Payment System (OPPS)? In this article, I will answer the following questions:

On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) final rule. This final rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings in calendar year 2024. In this article, I will inform you of what CMS finalized on the following topics:

On July 13, 2023, the Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) proposed rule. This proposed rule does have regulatory and reimbursement implications for outpatient physical, occupational, and speech therapy provided in all outpatient therapy settings. In this article, I will inform you of what CMS is proposing on the following topics:

The United States House of Representatives and United States Senate have both passed S. 610 which has 3 positive implications for providers of outpatient physical, occupational and speech therapy services for calendar year 2022. QuestionDoes S. 610 stop the 3.75% decrease in the 2022 Medicare Physician Fee Schedule Conversion Factor (CF) thereby halting the 3.75% percent decrease in payments for outpatient physical, occupational and speech therapy services in 2022? Answer QuestionDoes S. 610 stop the 4% pay-as-you-go (PAYGO) deficit control budget rules that was to go into effect in CY 2022 thereby further decreasing outpatient outpatient physical, occupational and speech

On January 5, 2021, the Centers for Medicare and Medicaid Services (CMS) published the revised conversion factor (CF) for services reimbursed under the Medicare Physician Fee Schedule (MPFS) for calendar year 2021. This would include outpatient therapy services provided in all outpatient therapy settings except for critical access hospitals since critical access hospitals are not reimbursed under the MPFS. The revised 2021 CF for services paid under the MPFS is In addition, I have created an excel spreadsheet that provides the Medicare allowed amount for the most common CPT codes billed by physical, occupational and speech therapy for calendar year

On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all outpatient therapy settings except for a critical access hospital. Highlights of the final rule include, but are not limited to, the following: 2021 Medicare Conversion Factor and 9% Payment Reduction Accessing the 2021 Relative Value Units (RVU’s) for Each CPT Code 2021 Annual Therapy Threshold Dollar Amount Student Documentation in the Medical Record Maintenance Therapy Provided by PTA’s and OTA’s Communication-Based

The Centers for Medicare and Medicaid Services (CMS) has released the calendar year (CY) 2021 Proposed Rule for services paid under the Medicare Physician Fee Schedule (MPFS). This would include outpatient physical, occupational and speech therapy services provided in all settings (private practice (both therapist-owned and physician-owned, skilled nursing facilities doing Part B, comprehensive outpatient rehabilitation facilities, rehabilitation agencies, home health agencies providing Part B therapy services in the home and hospital outpatient therapy departments). This proposed rule would not apply to outpatient therapy services provided by critical access hospitals (CAHs) since CAHs are not reimbursed under the MPFS. Highlights