CY2019 Physician Fee Schedule Final Rule

By: Cassie Murray, Chief Operating Officer I Chief Clinical Officer

The CMS Fact Sheet for the CY2019 Physician Fee Schedule Final Rule was released Thursday, November 1, 2018.

Note that CMS finalized the discontinuation of the Functional Status Reporting (G-Codes) for outpatient therapy services effective January 1, 2019.

Additionally, the payment reduction to 85% for outpatient therapy provided by PTAs and OTAs will go into effect January 1, 2022. CMS clarifies that the new modifiers for therapy provided by PTAs (CQ) and OTAs (CO) will be used alongside the current PT and OT modifiers (GP, GO, and GN). CMS explained that the new modifiers (and payment reduction) will apply when more than 10 percent of the service is furnished by the PTA or OTA. These new modifiers will be required on claims beginning January 1, 2020. The payment reduction will begin January 1, 2022.

For calendar year 2019, the KX modifier must be applied when therapy services reach $2,040.

Click here to read the CMS Fact Sheet.

Speak with your doctor to find out how therapy could benefit you!