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2021 Medicare Proposed Rule Released for Physical Therapy

Medicare's 2021 Proposed Final Rule Has Been Released

Trending with previous years, the proposed final rule was late this year – coming in August instead of July when it normally comes in. The 2021 CMS (Centers for Medicare & Medicaid Services) proposed final rule has been released. The proposed rule has some changes for physical therapy practices, occupation therapy practices, and speech practices as well. Typically, the proposed rule is left out there for comment and then ultimately a final rule is adopted later in the year (CMS is giving itself more time this year). The rule will go into effect January 1, 2021.

There are main areas that are of interest to private physical therapy and occupational therapy practices are:

2021 Fee Schedule
Maintenance Therapy
Telehealth
MIPS

Keep reading to learn more about where these areas are in the proposed final rule.

This is a proposed rule is hot of the presses and is nearly 1,360 pages long. More details will come as the document can be reviewed. This information is provided based on a read of the proposal but is subject to further interpretation and updates.

2021 Fee Schedule

Last year’s final rule contained provisions stating that a reimbursement reduction was coming to Physical Therapy and Occupational Therapy in 2021. At the time, this was somewhat devoid of details but was estimated to be at 8% cut. It remained to be seen at that time whether it was an across the board cut or limited to certain codes.

As of this proposed rule, the reduction is proposed to be 9%.

As of this blog post, it is still not clear how this 9% will be applied – across all applicable PT/OT codes or against certain codes and, if so, which ones. These cuts come as a result of the budget neutrality requirement which requires Medicare to balance new spending with cuts. APTA has already issued a statement continuing to advocate against these cuts.

Maintenance Therapy

Medicare is proposing to allow PTs or OTs in private practice to be able to establish a maintenance program and, as clinically appropriate, assign those duties to a PTA or OTA. This was added as a flexibility during COVID but it looks like the proposal is to make this a permanent fixture.

This would bring policy more inline with Medicare’s policies at skilled nursing facilities (part A) and home health rules.

Telehealth

Medicare continues to discuss telehealth services more in-depth. In one part of the proposal, they call out the following codes specifically:

Therapy Services, Physical and Occupational Therapy, All levels (CPT 97161- 97168; CPT 97110, 97112, 97116, 97535, 97750, 97755, 97760, 97761, 92521- 92524, 92507)

CMS' Proposed Rule

They state these are services they are NOT proposing to add to the telehealth service list but are seeking comment on whether these should be added permanently to the list of acceptable telehealth services either permanently or on a category III basis (which means emerging or new).

This means that Medicare reimbursing for actual telehealth sessions (not so-called e-visits, virtual check-ins, etc) will only last during the public health emergency unless authority is granted to CMS to recognize PTs/PTAs as telehealth providers on a permanent basis (e.g. beyond the current COVID-19 public health emergency).

MIPS

MIPS looks to be very similar in 2021 as it was in 2020. It appears that the low-volume threshold (perhaps one of the most important practical aspects) for MIPS will remain the same for 2021. Medicare also states that the low-volume threshold will remain the same for 2022.

With that said, MIPS is also up for further change as Medicare looks to develop policy around MIPS Value Pathways (MVPs – yes another new acronym). It’s not yet clear what this means practically but it seems that CMS is putting it off for at least a couple of years – at least 2022.

The Bottom Line

It’s always a challenging time between the proposed rule and final rule to figure out where things might be headed but previous efforts have proven that advocacy does have value and can help alter the course of the final rule. With that said, practices will have to contend with the proposals as we look towards 2021.

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