Proposed 2018 Medicare Physician Fee Schedule Includes Good News for Therapy Providers

Therapists received some welcome news last month when Medicare’s 2018 physician fee schedule proposed rule was released. Ever since CMS announced that it had identified several CPT codes commonly used by PTs and OTs that would be reviewed as potentially misvalued, therapists had been bracing for an adjustment in the RVUs that could have resulted in a considerable negative impact in reimbursement. However, CMS announced in the proposed rule that it agreed to maintain the values of 13 of the 19 codes under evaluation and even proposed small increases in the work RVU for the remaining six codes.

A quick summary of highlights from the proposed rule relevant to PTs and OTs:

• Thirteen of the 19 CPT codes reviewed by CMS as potentially misvalued would retain their 2017 RVUs. These codes include 97012, 97016, 97018, 97022, 97032, 97034, 97035, 97110, 97140, 97530, 97535, and G0283.

• Six of the 19 CPT codes reviewed by CMS as potentially misvlaued would see an increase in their work RVU:
97112 (from .45 to .50)
97113 (from .44 to .48)
97116 (from .40 to .45)
97533 (from .44 to .48)
97537 (from .45 to .48)
97542 (from .45 to .48)

• Practice expense (PE) RVUs would remain unchanged for all 19 codes.

• An increase in the conversion factor for 2018 from 35.8887 to 35.9903.

• Revision of the code descriptors by adding “initial encounter” to CPT codes 97760 (Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes), and 97761 (Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes).

• Creation of a new CPT code (977X1) with a descriptor of “Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes”.

• Deletion of CPT code 97762 (Checkout for orthotic/prosthetic use, established patient, each 15 minutes).

• The work RVUs for the revised 97760 and 97761 codes would be increased from 0.45 to 0.50 while the work RVU for the new 977X1 code would be set at 0.48. CMS proposed to maintain the current practice expense (PE) values for all three codes.

The final rule is expected to be published later in the fall. Stay tuned for more updates.