In the post-cap payment system, outpatient therapy services performed by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) will be reimbursed at 85% of the Medicare physician fee schedule—a change opposed by APTA. However, that's not set to happen until 2022.
Full Answer
How to calculate the percentage of care provided by the PTA/Ota?
Divide the number of minutes of care provided by the PTA/OTA by the total minutes of care provided then multiply by 100. That gives you the percentage of time of care provided by the PTA/OTA. You are to round to the nearest whole number. CMS says anything equal to or greater than 11% requires application of the modifier.
Will Medicare pay for outpatient therapy services provided by PTAS?
Beginning Jan. 1, 2022, payment for outpatient therapy services furnished by PTAs was reduced to 85% of the Medicare Fee Schedule. This cut, harmful by itself, is happening in addition to other cuts to the fee schedule.
Will PTA Medicare cuts impact your practice’s billing?
On the contrary, the newly imposed PTA Medicare cuts may still come as a surprise to some practices, or even cause complications for billing. To better understand how the final fee schedule could impact your practice, take a look at updates to PTA reimbursement in 2022.
What is the 85% payment rate for physical therapists?
This payment rate is 85% of the rate physical therapists and occupational therapists are paid. Well, CMS finalized the rule actualizing that legislation last year putting it into effect beginning January 2020.
How will Medicare cuts affect PTAs?
In short, reimbursement for partial and full services provided by physical therapy assistants and occupational therapy assistants will be slashed by 15% from the Medicare physician fee schedule.
How does Medicare reimburse physical therapy?
However, in 2018, the therapy cap was removed. Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. When you receive services from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible ($233 in 2022).
What settings do PTAs make the most money?
Private facilities generally pay more than public ones, and among those, home health care services, SNFs and ALFs pay the highest for PTA services. Experience Matters: Surveys have shown that PTAs with 5 years experience post-certification can expect to add about $5 to their hourly wage.
What is the PTA modifier?
Beginning January 1, 2020, CMS requires the use of the CQ modifier to denote outpatient therapy services furnished in whole or in part by a physical therapist assistant (PTA) in physical therapist (PT) private practices, skilled nursing facilities, home health agencies, outpatient hospitals, rehabilitation agencies, ...
How many PT sessions will Medicare pay for?
There's no limit on how much Medicare pays for your medically necessary outpatient therapy services in one calendar year.
What is the therapy cap for 2021?
Beginning January 1, 2021 there will be a cap of $2110.00 per year for Physical Therapy and Speech-language pathology together. A separate cap of $2110.00 per year is allowable for Occupational Therapy Services. Medicare pays 80% of allowable charges.
Which state pays PTAs the most?
Texas1. Texas. It pays the highest salary, has the greatest expected job growth, and currently employs the most PTAs.
Who is the highest paid physical therapist?
Physical Therapists made a median salary of $91,010 in 2020. The best-paid 25 percent made $106,060 that year, while the lowest-paid 25 percent made $75,360.
What type of physical therapist gets paid the most?
The most lucrative position in the physical therapy field is being a sports medicine specialist. Working with athletes can be very rewarding as well.
What is the difference between modifier PT and 33?
Modifier 33 is a valid CPT modifier and may be used for all payers. Check with individual payers for their instructions. Modifier PT is more specialized and will be used by fewer practices. It is a HCPCS modifier, used to indicate that a colorectal screening service converted to a diagnostic or therapeutic service.
Can a PTA bill for 97110?
The 7 minutes of 97110 furnished by the PTA do not result in billable service. However, document them within the total treatment time. E. Similar to Example D, but instead the PT independently furnishes 7 minutes of 97140, and the PTA independently furnishes 15 minutes of 97110.
When should modifier 33 be used?
If you provide multiple preventive medical services to the same non-Medicare patient on the same day, append modifier 33 to the codes describing each preventive service rendered on that day. You may also apply modifier 33 when a preventive service must be converted to a therapeutic service.