February 9, 2018 was a historical day: for over twenty years, providers have been advocating for Medicare Part B beneficiaries to receive medically necessary therapy services that exceed a capped amount! Our voices were heard, and the President signed the bill repealing the Medicare Part B caps!
This bill permanently repeals the caps beginning January 1, 2018. Providers are required to continue affixing the KX modifier on claims over $2,010. CMS is expected to provide some guidance related to billing of claims from January 1, 2018 to present but it is unknown when that will occur or in what format. The bill also lowers the targeted manual medial review threshold from $3,700 to $3,000.
Even though we are all very excited and celebrating, the bill has conditions in order to “pay for” the repeal. By the year 2022, any Medicare Part B therapy services provided by Licensed Occupational Therapy Assistants and Licensed Physical Therapist Assistants will be paid at 85% of the amount Medicare would otherwise pay for.
CMS will need to develop a modifier to mark the therapy services provided by an assistant. Development of this modifier is required by January 1, 2019. Providers will then need to affix this new modifier starting January 1, 2020, and the payment decrease will go into effect 2022.
The update to the Physician Fee Schedule for 2019 is also decreased from 0.50 percent to 0.25 percent and Medicare reimbursement for skilled nursing facility (SNF) providers will be limited to an increase of 2.4 percent in fiscal year 2019.
While we celebrate this as a victory, and we will continue to advocate for the residents we serve!