New CPT Codes Allow PTs to Conduct, Bill for Remote Monitoring

Sure, the biggest news from the 2019 Medicare physician fee schedule is the new reporting and payment system for many physical therapists (PTs), but that’s not the whole story: the 2019 rule also includes new current procedural terminology (CPT) codes that allow PTs to conduct and bill Medicare for remote monitoring of patient factors such as weight, blood pressure, and pulse oximetry.

Many questions remain as to how the US Centers for Medicare and Medicaid (CMS) will implement the new codes, and APTA is developing online resources that will supply further details as they become available.

Here’s what APTA knows so far: the new CPT codes apply to chronic care, and they allow physicians, clinical staff, or “other qualified healthcare professionals” to conduct remote monitoring in certain circumstances. Because PTs are included in the American Medical Association’s definition of  “qualified healthcare professionals” they are able to participate in the remote monitoring to the extent allowed by state and scope-of-practice laws.

Full story at APTA

Payment Cuts Avoided in Proposed 2018 Physician Fee Schedule

The proposed 2018 Medicare physician fee schedule (PFS) released today by the US Centers for Medicare and Medicaid Services (CMS) includes some positive news for physical therapists (PTs)—a proposal to maintain the values of some current procedural terminology (CPT) codes commonly used by PTs, and even increase values for a few.

The proposed rule is a win for the profession and its ability to serve patients. CMS had been reviewing many of the CPT codes as potentially misvalued, putting them at risk for sizable reductions. The proposal includes no such reductions, a reflection of several years of work by APTA and its partners to maintain code values. Proposed increases in a few of the codes further underscore the effectiveness of those efforts.

Full story payment cuts to 2018 physician fee at APTA

CMS Clears Up Error in Description of Which CPT Code Combinations Won’t Receive Full Payment

Apparently, physical therapists (PTs), occupational therapists (OTs), and the outpatient facilities they work for aren’t the only ones adjusting to the new Current Procedural Terminology (CPT) tiered coding set: recently, the Centers for Medicare and Medicaid Services (CMS) informed APTA that it’s revising its National Correct Coding Initiatives “procedure to procedure” edits, a long list of CPT code pairs that should not be reported together. That list of problematic paired codes included PT and OT evaluation and reevaluation codes.

It’s a complicated situation, but the bottom line is, CMS is making changes that should allow for full payment of PT and OT evaluation and reevaluations code combinations that previously resulted in erroneous payment denials or partial payment when the new code set was first adopted in January. Ironically enough, it appears the change is an attempt by CMS to correct an error in its National Correct Coding Initiative. Here’s a breakdown.

Full story of the new Current Procedural Terminology (CPT) tiered coding set at APTA

Final Fee Schedule Maintains Tiered CPT Coding System, No Tiers in Payment – With a Few Twists

As expected, the final 2017 physician fee schedule rule from the Centers for Medicare and Medicaid Services (CMS) doesn’t vary much from what was proposed earlier this year—including the new 3-tiered current procedural terminology (CPT) code system for physical therapy evaluations, all with the same payment rate. However, some new developments add a few positive elements to the picture.

The rule covers Medicare Part B services that apply to physical therapists (PTs), physicians, and other providers. APTA regulatory affairs staff is reviewing the final rule and will develop a more detailed summary in the coming weeks. In the meantime, here are some features of the new rule that affect PTs.

Full story of the final 2017 physician fee schedule rule at APTA

APTA Members: AMA Seeks Critical Input on Existing Physical Therapy CPT Code Values

APTA members are being alerted to be on the lookout for an important survey from the American Medical Association (AMA) that will help to shape values for certain existing physical therapy current procedural terminology (CPT) codes.

In the coming days, APTA will distribute an AMA survey to a random sampling of members about existing CPT codes related to physical therapist procedures, as part of the Centers for Medicare and Medicaid Services’ review of potentially “misvalued” codes. The survey is designed to determine the “professional work” value and time involved in the physical therapist’s provision of the services identified by each of these codes.

“Professional work value” includes the mental effort and judgment, technical skill, and psychological stress involved in providing the service.

Full story of existing Physical Therapy CPT code values at APTA

APTA Members: AMA Seeks Critical Input on Existing Physical Therapy CPT Code Values

APTA members are being alerted to be on the lookout for an important survey from the American Medical Association (AMA) that will help to shape values for certain existing physical therapy current procedural terminology (CPT) codes.

In the coming days, APTA will distribute an AMA survey to a random sampling of members about existing CPT codes related to physical therapist procedures, as part of the Centers for Medicare and Medicaid Services’ review of potentially “misvalued” codes. The survey is designed to determine the “professional work” value and time involved in the physical therapist’s provision of the services identified by each of these codes.

“Professional work value” includes the mental effort and judgment, technical skill, and psychological stress involved in providing the service.

Full story of AMA and CPT code values at APTA

Detailed Summaries Now Available on New CMS Rules for 2016

The final 2016 rules recently released by the Centers for Medicare and Medicaid Services (CMS) have been analyzed by APTA regulatory affairs staff, and the following summaries are now available:

Physician Fee Schedule
The final rule for the 2016 physician fee schedule includes a slight overall payment increase, the expansion of several quality measures, and continued examination of potentially “misvalued” current procedural terminology (CPT) codes, including 10 related to physical therapy.
Full APTA summary of final rule; PT in Motion News article with highlights.

Home Health Prospective Payment System
The final home health rule includes an estimated overall 1.4% payment reduction that’s smaller than the reduction originally proposed, and the introduction of a new value-based model that will be used in 9 states.
Full APTA summary of final rule; PT in Motion News article with highlights.

Fore more information on the new CMS rules for 2016, visit APTA

New Wound Treatment Code Available to PTs

A new code for the use of a modality to heal wounds using sound energy has been made available to physical therapists (PTs) in the 2014 version of the Current Procedural Terminology (CPT) document maintained by the American Medical Association (AMA).

The new active wound care management code—97610—replaces Category III code 0183T. The modality uses acoustic energy to atomize saline and deliver ultrasound energy by way of a continuous mist to the wound bed and surrounding tissue, and is identified as “low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day.”

For more information on the new treatment code, visit APTA

CPT Editorial Process Emphasize Transparency

Recently announced changes to the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) editorial process emphasize greater transparency and collaboration, and could bolster opportunities for physical therapists (PTs) to work with APTA to ensure the codes accurately reflect practice.

The changes put in place are the result of input received by AMA from stakeholder organizations. According to an AMA press release, the new approaches are designed to “increase transparency and fairness” in the process through more in-person meetings beyond the CPT editorial and advisory committee, more wide and proactive communication about requested code changes, and the establishment of a “medical advisor” to facilitate the process with staff and applicants new to the CPT process.

Full story of changes to CPT at APTA