Attached is the 2021 Medicare Part B fee schedule, effective 1/1/21 through 12/31/21. To identify the fee amount for your facility, please locate the appropriate CPT/HCPCS code and match it to the respective facility location column.
As a reminder, the Medicare Part B outpatient therapy cap (KX Modifier) amounts are updated and are $2,110 for occupational therapy, and $2,110 for physical therapy and speech therapy services combined for CY 2021. The targeted medical review process, now-termed Medical Review threshold, amount is $3,000 for PT and SLP services combined and $3,000 for OT services. The Final Rule also reminds providers that the application of therapy caps and therapy caps exception process was repealed effective 1/1/18.
Please refer to the AHCA bulletin below, which provides details of the methodology, as well as related CMS links.
On January 5, 2021 the Centers for Medicare and Medicaid Services (CMS) posted updated rate files for the calendar year (CY) 2021 Medicare Part B Physician Fee Schedule (PFS). While each Medicare Administrative Contractor (MAC) is required to post rate tables applicable to their geographic coverage areas, AHCA/NCAL has incorporated these tables into a reference Microsoft Excel CY 2020 outpatient therapy fees file for members here. The AHCA/NCAL tables provide geographic-adjusted rates for Medicare Part B physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services billed under the PFS.
The fees effective January 1, 2021 are calculated slightly differently than in prior years.
First, they based upon the CY 2021 Payment Policies Under the Physician Fee Schedule (PFS) and Other Changes to Part B Payment Policies Final Rule ( CMS-1734-F ) ( Transmittal 10505/Change Request 12071 ) published in the Federal Register on December 28, 2020. This major final rule revised payment polices under the Medicare PFS and made other policy changes, including the implementation of certain provisions of the Bipartisan Budget Act of 2018 (BBA of 2018) (Pub. L. 115–123, February 9, 2018).
What is different is that the Consolidated Appropriations Act, 2021 (Pub. L. 116-260, December 27, 2020) modified the FY 2021 MPFS providing a 3.75% increase in MPFS payments for CY 2021, suspended the 2% payment adjustment (sequestration) through March 31, 2021, and reinstated the Work GPCI floor through CY 2023. Additionally, as required by the ACA, the 1.5 work GPCI floor for Alaska and the 1.0 practice expense GPCI floor for frontier states are permanent, and therefore, applicable in CY 2021.
Other policies impacting outpatient therapy payment coverage and rates in CY 2021 include:
- Continuation of the multiple procedure payment reduction (MPPR) policy for “always therapy” services.
- The permanent addition of five new Communication Technology-Based Services (CTB) codes as well as the temporary use of three additional CTB codes during the remainder of the COVID-19 public health emergency (PHE).
- Annual update to the KX modifier per-beneficiary threshold amounts for CY 2021 of $2,110 for PT and SLP services combined, and $2,110 for OT services.
- Continuation of the targeted medical review process, now-termed Medical Review threshold, with amounts remaining at $3,000 for PT and SLP services combined and $3,000 for OT services.
While the CY 2020 conversion factor was $36.0896, the Final Rule initially reduced the CY 2021 conversion factor to $32.4085. However, the CY 2021 conversion factor was further adjusted upwards to $34.8931 reflecting provisions included in the Consolidated Appropriations Act, 2021.
The 2021 therapy fees for each CPT/HCPCS Code in each geographic area are provided in the AHCA/NCAL outpatient therapy fees file for members here. The file contains detailed background information and useful links to source policies and reference tables in the “Overview” tab. The “Part B Fees” tab contains the geographic adjusted rates for each geographic location. The “MPPR Fees” tab contains the adjusted rates for services subject to the MPPR policy. The remaining three tables are reference tables.
Carl J. Pucci
Chief Financial Officer