Physician Fee SchedulePhysician Fee Schedule

The 2017 proposed Physician Fee Schedule has now been released. As a result, CMS (Centers for Medicare and Medicaid Services) is providing those that specialize in physical therapy the very first glimpse of a new coding system. This allows for the different levels of evaluation complexity performed by those therapists.

The CMS is recommending that all physical therapists are trained on how to use the new system so that it benefits their practice, as well as the patients that they serve. In their push for this, CMS is also conducting an evaluation on the codes that they feel are currently not appropriately valued. To date, that includes 10 of the most commonly used codes within the practice.

The proposal that has now been released claims that the evaluation codes will be tiered; however, prices will not. The codes will be outlined as “low”, “moderate”, and “high”. Instead of pricing each in an individual fashion, they will be priced as a group.

This is against the recommendations by the American Medical Association’s Relative Value Scale special committee, but CMS feels that it is the most productive model. In order for these codes to be as beneficial as they are designed to be, all physical therapists will need to engage in training sessions to become educated on them. This education is also part of the proposal that has recently been released to physical therapists.

The current proposal outlines the fact that there are 10 commonly used codes in physical therapy that are considered to be inappropriately valued. It continues by stating that these are currently works in progress.

These codes include electrical stimulation, self-management care training, ultrasound therapy, electrical stimulation that does not involve wounds, therapeutic exercises, therapeutic activities, neuromuscular reeducations, gait training therapy, aquatic exercises/therapy, and manual-based therapy.

Unfortunately, Congress has only allotted for a .5% target for all of the misvalued codes in the entire medical community. CMS believes that a .51% net expenditure reduction in physical therapy services, alone, is more appropriate.

The conversion rates as outlined by CMS have not yet been published. These will be released in the final ruling – which will be either October or November. CMS has also proposed the addition of many different codes to the list of services that they want to be offered by telehealth; however, they have stated that no additional physical therapy codes will be added.

This is because it has been established that physical therapists are not considered to be authorized providers under the telehealth services. In order to add physical therapists as providers, congressional action would be required.

In addition to the proposed fee schedule, several other updates have been released. These include putting restrictions on provisions for self-referrals, a new prevention program for diabetes, and new provider requirements for the Medicare Advantage program.

As a physical therapist, you are facing new challenges; however, the goal is to provide benefits to practitioners.

If you would like to learn more about the congressional-based changes for physical therapists, visit us today at: https://coloradophysicaltherapynetwork.com/
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