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:
- The 2018 Medicare Part B Fee Schedule for Outpatient Rehabilitation for each Carrier and Locality (Part B Fees)
- The 2018 Medicare Part B MPPR Fee Schedule for "Always Therapy Services (50% MPPR Factor) for each Carrier and Locality (MPPR Fees)
- The 2018 Relative Value Units for each Outpatient Rehabilitation Therapy Code (RVUs)
- The 2018 Geographic Practice Cost Indices by Medicare Carrier and Locality (GPCI)
- 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:
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
|
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