Tuesday, March 6, 2018

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:


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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