After a brief shutdown and a Rand Paul minifilibuster, Congress passed a “Bipartisan Budget Bill” and, as the issue of Part B News released just before the vote predicted, it addressed two big Part B payment issues that we’ve been covering: the expiration of the Work GPCI floor and the expiration of the therapy cap exception.
There's also a change to how certain therapy assistants are paid for services.
The reinstatement of the Work GPCI floor was handled with a simple extension of the next deadline to Jan. 1, 2020.
The therapy cap exception was addressed by what the bill refers to as a “Repeal of [the] Medicare Payment Cap for Therapy Services.” At first glance, though, it seems only to reinstate the previous conditions: the use of the KX modifier for claims that exceed the cap, and targeted medical review for such claims.
Justin Elliott, vice president for government affairs at the American Physical Therapy Association (APTA), explains to Part B News that what Congress has done is make “a permanent fix for the hard therapy cap by permanently extending the current exceptions process, eliminating the need to fix this issue from year to year, as well eliminating the threat of a hard cap being put into place in the future.”
What remains is a process for adjusting the cap and the review threshold. The current $2,010 cap will be adjusted annually — and providers will still use of KX modifier to attest that services were medically necessary to beat the cap. The threshold for targeted medical review will be incrementally lowered from the current $3,700 to $3,000 through 2027.
There’s another change in the bill that neither Elliott nor APTA is so happy about, though: A requirement that, starting on Jan. 1, 2022, services rendered by a physical therapy or occupational therapy assistant, as opposed to a fully licensed therapist, be paid at 85% of the Part B physician fee schedule. The bill also calls for CMS to establish a new modifier to distinguish outpatient claims on services provided by these assistants by 2019.
“This policy was not part of any of our discussions or negotiations on Capitol Hill over the past year, nor was it included as part of the proposed package of pay-fors that were announced this past fall as part of the bipartisan, bicameral agreement,” says Elliott, who adds that APTA will work to get this changed.
Follow Part B News and this blog for further coverage of the health care impacts of this bill.