PALTC Fee Schedule Changes 8: Therapy Services Payment

https://saisystems.com/health/project...

On Nov. 2, 2021, the Center of Medicare & Medicaid Services (CMS) issued the Medicare Physician Fee Schedule (PFS) for Calendar Year (CY) 2022 final rule on behalf of the Department of Health and Human Services.

The 2414-page-long document finalizes some across-the-board policy changes that will profoundly impact practice revenues, bringing both potential benefits and negative effects.

Out of all those changes, post-acute long-term-care providers and practices should watch these 8 policy adjustments and make necessary preparations to counter any negative impacts and maximize any benefits.

8. Therapy Services Payment
The PFS for CY 2022 finalized the 15% cut to payment for physical therapy and occupational therapy services provided in whole or part by physical therapy assistants (PTA) or occupational therapy assistants (OTAs). This cut will apply to service dates on or after Jan. 1, 2022.

The payment cut will be implemented through the use of new modifiers, CQ and CO. CMS also revised its de minimis policy to define which services will the payment cut apply to. Specifically, a 15-minute timed service can be billed without the CQ/CO modifiers when a PTA or OTA participates in providing care, independent of the PT/OT, but the PT/OT provides more than the 15-minute mid-point (8 minutes).

De minimis standard also applies to the case of two 15-minute units. If the PT/OT and the PTA/OTA each provide between 9 and 14 minutes of the same service, totaling between 23 and 28 minutes, one unit can be billed without the CO/CQ modifier.

Discover the other 7 important changes in our analysis.

https://saisystems.com/health/project...

More information regarding PALTC Practice Support.
https://saisystems.com/health/paltc-p...