Spotlight Archive

Functional Reporting: PT, OT, and SLP Services Frequently Asked Questions Document Now Available

On June 19, CMS released a new Frequently Asked Questions (FAQ) document on Functional Reporting for PT, OT, and SLP Services. Please view the new FAQ document here (PDF).

Therapy Services Updated  

This Therapy Services landing page is being updated to reflect the therapy provisions of the Bipartisan Budget Act of 2018 (BBA of 2018). It adds a new section titled “Latest Applicable Law” to replace the “Therapy Caps” section; and it also adds an Advance Beneficiary Notice of Noncoverage (ABN) Frequently Asked Questions (FAQ) document to the Downloads section – See “August 2018 ABN FAQs”. This spotlight was added August 2018.

MPPR Rates for CY 2018 Available

Medicare applies a multiple procedure payment reduction (MPPR) to the practice expense component of certain “always therapy” services. Since April 1, 2013, this MPPR rate is 50 percent for both practitioner/office and institutional settings. The “MPPR Rate File” was recently updated for CY 2018 and can be found in the Downloads section of this webpage. This spotlight was added December 2017.

MPPR Rates for CY 2017 Available

Medicare applies a multiple procedure payment reduction (MPPR) to the practice expense component of certain therapy services. Since April 1, 2013, this MPPR rate is 50 percent for both office and institutional settings. The “MPPR Rate File” was recently updated for CY 2017 and can be found in the Downloads section of this webpage. This spotlight was added December 2016.

New Physical Therapy (PT) and Occupational Therapy (OT) Evaluative Procedure Codes Created for CY 2017

Beginning January 1, 2017, physical and occupational therapists will use eight new CPT codes to bill Medicare for the evaluations and re-evaluations they furnish (97161 – 97168). Each of the existing PT and OT evaluation codes (97001 & 97003) was replaced with three new codes – representing low, moderate or high complexity: (a) codes 97161, 97162, and 97163 for PT; and (b) codes 97165, 97166, and 97167 for OT. The new PT and OT re-evaluation codes, 97164 & 97168, replaced the existing codes (97002 & 97004). 

The new CPT code descriptors for PT and OT evaluative procedures include specific components that are required for reporting as well as the corresponding typical face-to-face times for each service. These new codes represent “always therapy” services and always require the corresponding discipline-specific therapy modifier: (a) the new PT codes (97161 – 97164) require the “GP” modifier, and (b) the new OT codes (97165

Therapy Caps Exceptions Process Extended Through CY 2017

The therapy caps exceptions process for PT, OT, and SLP services was extended through the remainder of CY 2015, and for all of CY 2016 and CY 2017, when the Medicare Access and CHIP Reauthorization Act was signed into law on April 16, 2015.

Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet)

As explained in the previously-issued Jimmo v. Sebelius Settlement Agreement Fact Sheet (see Downloads section on the SNF PPS web page), the Centers for Medicare & Medicaid Services (CMS) is issuing revised portions of the relevant program manuals used by Medicare contractors.  For additional information, please see the  Jimmo v. Sebelius Settlement Agreement – Program Manual Clarifications (Fact Sheet) - Updated 2/3/2014 (PDF)  

Page Last Modified:
10/09/2019 05:17 PM