CMS Updates 2018 Medicare Part B Physician Fee Schedule File to Reflect Bipartisan Budget Act of 2018 Provisions – Updated Therapy File Posted on AHCA Website

Dan Ciolek

On February 9, 2018 the President signed into law the Bipartisan Budget Act of 2018.  Within this law were provisions that positively impact the payment rates for providers in certain geographic regions for Medicare Part B procedures, including outpatient physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services.  This payment rate improvement is to be applied retroactively to January 1, 2018.

You can see a list of localities positively impacted at the bottom of this article.  No new provider action is necessary for implementation as Medicare contractors will automatically apply the payment rate adjustment for services furnished in 2018. 

Previously, as described in a November 28, 2017 Long Term Care Leader article AHCA had posted the MPFS 2018 therapy fees for each CPT/HCPCS Code in each geographic area on our website under the “Medicare Part B Fee Schedules” heading. These fees effective January 1, 2018 were calculated based upon the Revisions to Payment Policies Under the Physician Fee Schedule (MPFS) and Other Revisions to Part B for Calendar Year (CY) 2018 Final Rule (CMS-1676-F) published in the Federal Register on November 15, 2017.  Due to the recent law, that file is no longer accurate for providers in the 52 geographic areas impacted.  The following paragraphs provide information about the updated 2018 therapy fee schedule file posted on the AHCA website. 

Thanks again to the efforts of Tony Marshall, President and CEO of the Georgia Health Care Association; AHCA is able to offer members the February 2018 update to the 2018 therapy fees for each CPT/HCPCS Code in each geographic area on our website under the “Medicare Part B Fee Schedules” heading.

Please note that these updated fees effective January 1, 2018 reflect provisions related to Medicare payment contained in the Bipartisan Budget Act of 2018 signed into law on February 9, 2018. Specifically, Section 50201 - Extension of Work Geographic Practice Cost Index (GPCI) Floor - extends a provision raising the Work GPCI to 1.000 for all localities that currently have a Work GPCI of less than 1.000. The Work GPCI Floor impacts the fees for all codes paid under the Medicare Physician Fee Schedule (MPFS) for those localities. The Work GPCI floor is extended through December 31, 2019.

The updated 2018 therapy fees for each CPT/HCPCS Code in each geographic area can be found here. The Excel file includes five tabs containing the following information:

1. The 2018 Medicare Part B Fee Schedule for Outpatient Rehabilitation for each Carrier and Locality (Part B Fees)
2. The 2018 Medicare Part B MPPR Fee Schedule for "Always Therapy Services (50% MPPR Factor) for each Carrier and Locality (MPPR Fees)
3. The 2018 Relative Value Units for each Outpatient Rehabilitation Therapy Code (RVUs)
4. The 2018 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)
5. The 2018 Counties Included in 2018 Localities (GPCI Counties) (Same as 2017)

The Part B Fee Schedule amounts are calculated as follows:
        ((A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and

        ((A1 x B1) + ((A2 x B2) x (1-MPPR Factor) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where:

        A1 = Physician Work RVU
        A2 = Non-Facility Practice Expense RVU
        A3 = Malpractice RVU
        B1 = Work GPCI
        B2 = Practice Expense GPCI
        B3 = Malpractice GPCI
       
        Conversion Factor = $35.9996
       
        MPPR Factor = 50%

Additional Resources:

Medicare Expired Legislative Provisions Extended and Other Bipartisan Budget Act of 2018 Provisions

Physician Fee Schedule (MPFS) and Other Revisions to Part B for Calendar Year (CY) 2018 Final Rule (CMS-1676-F) November 15, 2017 Federal Register

Regulation #CMS-1676-F

2018 Annual Update to the Therapy Code List Transmittal 3924/Change Request 10303

Centers for Medicare and Medicaid Services (CMS) MLN Matters article MM10303

Physician Fee Schedule Payment Policies

Skilled Nursing Facility Consolidated Billing and Annual Updates

List of localities positively impacted by the Bipartisan Budget Act of 2018 GPCI floor provisions

Medicare Administrative Contractor	Locality Number	Locality Name
10102	00	ALABAMA
03102	00	ARIZONA
07102	13	ARKANSAS
04112	01	COLORADO
09102	03	FORT LAUDERDALE, FL
09102	04	MIAMI, FL
09102	99	REST OF FLORIDA
10202	01	ATLANTA, GA
10202	99	REST OF GEORGIA
02202	00	IDAHO
06102	12	EAST ST. LOUIS, IL
06102	99	REST OF ILLINOIS
08102	00	INDIANA
05102	00	IOWA
05202	00	KANSAS
15102	00	KENTUCKY
07202	01	NEW ORLEANS, LA
07202	99	REST OF LOUISIANA
14112	03	SOUTHERN MAINE
14112	99	REST OF MAINE
08202	99	REST OF MICHIGAN
06202	00	MINNESOTA
07302	00	MISSISSIPPI
05302	02	METROPOLITAN KANSAS CITY, MO
05302	01	METROPOLITAN ST. LOUIS, MO
05302	99	REST OF MISSOURI
03202	01	MONTANA
05402	00	NEBRASKA
14312	40	NEW HAMPSHIRE
04212	05	NEW MEXICO
13282	99	REST OF NEW YORK
11502	00	NORTH CAROLINA
03302	01	NORTH DAKOTA
15202	00	OHIO
04312	00	OKLAHOMA
02302	99	REST OF OREGON
12502	99	REST OF PENNSYLVANIA
09202	20	PUERTO RICO
11202	01	SOUTH CAROLINA
03402	02	SOUTH DAKOTA
10302	35	TENNESSEE
04412	31	AUSTIN, TX
04412	20	BEAUMONT, TX
04412	99	REST OF TEXAS
03502	09	UTAH
14512	50	VERMONT
11302	00	VIRGINIA
09202	50	VIRGIN ISLANDS
02402	99	REST OF WASHINGTON
11402	16	WEST VIRGINIA
06302	00	WISCONSIN
03602	21	WYOMING