The therapy cap for 2010 is $1860, unless it is eliminated or exceptions are allowed as they are now.
Medicare Payments for PTs to be Cut in 2010 Unless Congress Steps In
Unless Congress takes action through health care reform legislation, payments for physical therapy services under the Medicare physician fee schedule will be reduced by 19.2% in 2010. In issuing its final rule for calendar year 2010, the Centers for Medicare and Medicaid Services last week announced a negative 21.2% update for providers. For PTs, this negative update would be offset by a 2% positive adjustment in 2010 due to practice expense changes, resulting in an aggregate impact of negative 19.2%. The amount of payment for each service would vary depending on the CPT code.
APTA has prepared a detailed highlights document of provisions in the final rule that will have an effect on physical therapy. They include:
*An increase in the dollar amount of the therapy caps in 2010 to $1,860. Both the House and Senate reform proposals include a 2-year extension of the therapy cap exceptions process, which is set to expire December 31.
*A new comprehensive pulmonary rehabilitation program (PR) and an expansion of the current cardiac rehabilitation (CR) program to contain services for intensive cardiac rehabilitation. The rule contains a brief discussion on how to bill for certain patients with therapy needs that are outside of the treatment plan appropriate for PR, CR or Intensive cardiac rehabilitation.
*Plans for continuation of the Physician Quality Reporting Initiative (PQRI). In 2010, physicians and other health care providers, including physical therapists, who successfully participate in the PQRI program will receive a bonus payment equal to 2.0% of the estimated total allowed charges for all services in 2010. Physical therapists will be able to use claims-based and registry-based reporting.
*A final proposal to change the status indicator for canalith repositioning from B (Bundled) to I (Invalid). The rule notes that physical therapists can continue to bill for this service with CPT code 97112 (neuromuscular reeducation).
You can visit the APTA's Patient Action Center at www.apta.org/consumer/action.
APTA's press release as of 01/29/10 is at:
http://www.apta.org/AM/Template.cfm?Section=Media&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=68709
