Proposed 2022 Changes to Medicare Billing for Physical Therapists

Transparency for patients and providers. Special relative value codes that provide reimbursement. Payment differentials. Physical therapy billing and documentation are changing in 2022 and Kareo wants to keep you in the know.

October is National Physical Therapy Month and we at Kareo appreciate all the physical therapy practitioners who provide valuable cost-effective relief to people with various conditions. This discipline has been around for 100 years, with more than 220,000 physical therapists working in the US today.

As the owner of a physical therapy practice, and the billers who support you, here is what you need to know about how physical therapy reimbursement is evolving and the proposed billing changes coming in January 2022:
  • The payment landscape for health services is moving more toward patient outcomes (value-based models), and away from fee-for-service/volume-centric structures. Is your business model poised to handle the changes ahead?
  • In 2020, the Centers for Medicare and Medicaid Services (CMS) revealed the Transparency in Coverage final rule.

Beginning in January 2022, the rule will promote healthcare cost transparency for patients and providers. This means:
  • Patients will be able to better understand and plan for the cost of medical procedures and services.
  • Insurance payers will have to divulge how much they reimburse providers.
  • Patients can make better healthcare choices and budget-friendly decisions.
  • Less surprise out-of-pocket costs for patients.
In 2022, the rule only applies to hospitals and skilled nursing facilities, but private practice physical therapists will be incorporated into the program later. Payers and hospitals will have to post data sets. Everyone will have access to data on care cost and utilization from both federal and private payers. Advocacy groups will be able to promote access to care and measure the success of the care.

Proposed Physical Therapy Billing Code Changes

CMS is cutting some therapy CPT codes but increasing some relative value units (RVUs) for PT and OT codes in 2022. It is adding three new remote therapeutic monitoring (RTM) codes.

They are:
  • 989X1: Remote therapeutic monitoring; initial set-up and patient education on use of equipment
  • 989X4: Remote therapeutic monitoring treatment management services, physician/other qualified health care professional team in a calendar month requiring at least one interactive communication with the patient/caregiver during the calendar month; first 20 minutes
  • 989X5: Each additional 20 minutes (list separately in addition to code for primary procedure)

Also be aware that payment for outpatient therapy services furnished by physical therapist assistants will be reimbursed at 85 percent of the Medicare Physician Fee Schedule. The American Physical Therapy Association is lobbying CMS and Congress to delay the payment differential to enable recovery from the effects of the pandemic and access to care in rural and underserved areas.

If you are a physical therapist (or biller who supports this specialty), visit us here to see how Kareo can help you with your billing and EHR needs.


Keeping up with the Changes

Mandates for billing and reimbursement are constantly changing. Your practice needs to be evolving with them.

As a physical therapy practitioner, Kareo offers an easy-to-use platform to manage your clinical, billing, patient collections, and marketing needs. We help you to optimize your physical therapy practice. You simply choose a plan that’s tailored to meet your needs. We have the tools and reports you need to get paid faster the first time, with less effort.

Let Kareo take the worry out of changing with the times. Let us keep up with CMS administrative initiatives while you keep up with the best practices in physical therapy.

For more information on how Kareo can help your physical therapy practice (or client) with billing and EHR needs, visit us here.

About the Author

Ilene Schneider, owner of Schneider the Writer, provides communications support to health care, technology, educational and service enterprises. Ilene has an extensive...

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