Medicare Changes


9% Medicare Cut reduced to 3.6%  
A message from Sharon Dunn APTA President:

After months of advocacy by APTA members, Congress partially addressed the projected 9% payment cut for physical therapist services under the Medicare Physician Fee Schedule that’s set to go into effect Jan. 1. The COVID-19 relief package, announced yesterday, includes $5 billion in offsets that will reduce the cuts from an average of about 9% to an average of about 3.6%. This relief falls well short of ensuring patient access to needed services, and a 3.6% cut threatens the viability of thousands of providers who offer safe, cost-effective care that helps older adults maintain their independence and avoid more costly procedures.


MIPS Final Rule:

Like the proposed version, the final rule from CMS keeps the Quality Payment Program mostly as-is.


NCCI Edit information - December, 2020 

CMS Releases Coding Edits With Possible Good News for PTs CMS has released the list of Medicare National Correct Coding Initiative procedure-to-procedure edits that will take effect Jan. 1, 2021. Many of the PTP edits for common physical therapy code pairs have been deleted; APTA staff are currently reviewing the files in detail to identify all the changes. One early finding: We’ve determined that the problematic edits that prohibited the billing of codes 99281-99285 with codes 97161-97164 have been deleted. We’ll share more detailed information about all the changes as soon as possible. The updated list of PTP edits can be found at the CMS NCCI coding edits page.

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