BREAKING NEWS Medicare Physician Fee Schedule (PFS) Final Rule

The Centers for Medicare and Medicaid Services (CMS) issued the CY 2021 Medicare Physician Fee Schedule (PFS) Final Rule on Dec 1st, 2020. In this Final Rule, CMS is finalizing its proposals to update Med B payment policies, payment rates, telehealth policies, and quality provisions for services furnished under Med B on or after January 1, 2021.

2021 Conversion Factor and Payment Reduction
CMS has made the decision to finalize its policy on increasing payment for E/M codes in order to place more resources in specialties that provide primary care. Unfortunately, because of budget neutrality requirements, the increase in these E/M codes forces a reduction in payment in other specialties. The overall decrease in payment for PT and OT services will be approximately 9% in calendar year 2021 and a 6% decrease for ST. The 2021 conversion factor will be $32.41. This is a 10.2% decrease from the 2020 conversion factor of $36.09.

On October 30th, the House of Representatives introduced bipartisan legislation that provides for a potential fix to the fee schedule cuts slated to take effect on January 1, 2021. The bill is entitled, the Holding Providers Harmless from Medicare Cuts During COVID-19 Act of 2020 (H.R. 8207). The bill would ensure payments to providers expecting to receive a cut in 2021 under the E/M proposal are kept stable at 2020 levels for the next two years. The intent is to get this bill included in a legislative package before the end of the year.

Other Highlights of the Final Rule:· 
· A 2021 annual therapy threshold dollar amount was not included in the final rule
· Therapy students can document in the medical record so long as it is reviewed and verified (signed and dated) by the billing therapist
· Grants a physical therapist (PT) and occupational therapist (OT) the discretion to delegate the performance of maintenance therapy services, as clinically appropriate to a physical therapist assistant (PTA) or an occupational therapy assistant (OTA)
· The value of PT/OT/ST evaluation codes have been increased
· CMS stated they do not have the authority to add PT/OT/ST providers to continue telehealth services once the PHE ends

Preferred Therapy Solutions is part of a large coalition of provider organizations, who are troubled that during a pandemic is not the time to reduce payments to essential Medicare providers.

We still have hope and we are requesting Congress to include legislation in any year-end proposal to prevent these arbitrary Medicare cuts.

Congress needs to understand the difficult environment we are working in daily and to realize these cuts would have a devastating impact on long-term care. Please click on the link below and contact your member of Congress.

The pre-publication final rule can be found Here.

CMS’ Fact Sheet on the final rule can be found Here.
Preferred Therapy Solutions continues to provide its partners with vital information that may impact rehabilitation management, reimbursement policies, and clinical programs, supported with compliance and regulatory requirements that are necessary for a thorough understanding of practices and procedures. If you have any questions, please contact  Maria Maggi, Vice President of Quality, Outcomes, and Compliance at: