Medicare Final 2020 Physician Fee Schedule (PFS) Released & Rule Includes Challenges for Part B Therapy Providers

CMS released the final 2020 Medicare Physician Fee Schedule on November 1, 2019 which includes updates to payment policies, rates and quality provisions under the PFS effective January 1, 2020.

Several clarifications impact part B therapy including the following:

  • Planned 8% cut to part B therapy in 2021
  • CQ Modifiers to identify therapy services furnished in whole or in part by a PT or OT assistant (per the CY2019 PFS final rule) were discussed and set a de minimum 10 percent standard for when these modifiers will apply to specific services. APTA has clarified that “when the same service (code) is furnished separately by the PT and PTA, CMS will apply the de minimis standard to each 15-minute unit of codes—not on the total PT and PTA time of the service, allowing the separate reporting, on two different claim lines, of the number of units to which the new modifiers apply and the number of units to which the modifiers do not apply” (APTA press release.) Effective January 1, 2022, a 15% reduced payment rate will be applied to part B therapy services furnished by a PTA or OTA based on the de minimis standard. CQ modifiers are mandated on 2020 claims for the “practice phase” of implementation. 

The KX modifier threshold amount was raised from $2040 to $2080 for PT and SLP combined, and by the same amount for OT. The targeted medical review threshold will continue to be $3000.

CMS will host a MLN update call to review the PFS and OPPS/ASC Final Rules on Nov. 6th at 2:15 ET. Click here to register.

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Blog by Amie Martin, OTR/L, CHC, RAC-CT, President, Proactive Medical Review

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