On August 3, 2020, the Centers for Medicare and Medicaid Services (CMS) issued 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).
One of the CMS proposals is to decrease the MPFS conversion factor to $32.26, a decrease of $3.83 from the CY 2020 MPFS conversion factor of $36.09. This significant decrease in the conversion factor is estimated to reduce payment for outpatient physical, occupational and speech therapy services by over 9% in CY 2021.
What providers want to know is how much will each CPT code be reduced in 2021 compared to 2020. In this article, I will provide the 2020 Medicare allowed amount for 1 unit of some of the more common CPT codes billed and compare it to the projected 2021 Medicare allowed amount for 1 unit of the same CPT code. In all of my examples, I will use Detroit, Michigan as the payment locality.
Keep in mind that some CPT codes will see a greater than 9% decrease while others will see less than a 9% decrease due to changes in the relative value units (RVUs) of each CPT code. For a more detailed explanation of how CMS determines the payment for each CPT code, click HERE to read an article I published on August 24, 2020.
Treatment of Speech and Language
Evaluation of Speech Fluency
Evaluation of Speech Sound Production
Behavioral and Qualitative Analysis of Voice and Resonance
Treatment of Swallowing Dysfunction
Evaluation of Oral and Pharyngeal Swallowing Function
Physical Therapy Evaluation, Low Complexity
Occupational Therapy Evaluation, Low Complexity
Orthotic Management and Training, Initial Encounter
Prosthetic Training, Initial Encounter
Orthotic/Prosthetic Management and/or Training, Subsequent Encounter
As you see, the percent change in payment for each of the above CPT codes is slightly different based upon each CPT codes’ work, practice expense and malpractice relative value units.
Keep in mind that Congress must intervene to stop the significant decrease in the 2021 Conversion Factor that causes the overall 9% decrease in payment for outpatient physical, occupational and speech therapy services.
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