by Rick Gawenda, PT
President, Gawenda Seminars & Consulting
On Dec. 22, 2023, and Dec. 23, 2023, the United States Senate and United States House of Representatives, respectively, passed the Consolidated Appropriations Act of 2023. This legislation was then signed into law by President Biden.
This legislation contained several items that will impact outpatient physical, occupational and speech therapy services in 2023 and 2024. Below, I highlight five of these items.
Medicare Physician Fee Schedule (MPFS) Conversion Factor (CF)
Per the 2023 Final Rule for Services Reimbursed Under the MPFS released on Nov. 1, 2022, the 2023 CF was estimated to be 33.0607. This was an approximate 4.47% reduction compared to the 2022 CF of 34.6062.
Due to the passage of the Consolidated Appropriations Act of 2023, Congress will provide an additional 2.5% increase to the 2023 CF. This means the 2023 CF will be 33.8872, which is an approximate 2.08% decrease from the 2022 CF.
Outpatient Therapy Services Delivered via Telehealth
Prior to the passage of the Consolidated Appropriations Act of 2023, the Centers for Medicare and Medicaid Services (CMS) would pay for outpatient therapy services delivered via telehealth for 151 days following the end of the public health emergency due to COVID-19.
Due to the passage of the Consolidated Appropriations Act of 2023, CMS will reimburse for outpatient therapy services delivered via telehealth through December 31, 2024.
Currently, the Medicare program does not cover and reimburse for lymphedema garments. CMS will begin to reimburse for lymphedema standard and custom-fitted gradient compression garments and other items as determined by the Secretary of Health and Human Services (HHS) beginning January 1, 2024.
Items will need to be prescribed by a physician, physician assistant, nurse practitioner or clinical nurse specialist.
The Secretary of HHS will determine an appropriate payment basis for lymphedema compression treatment items as well as the frequency limitations for lymphedema compression treatment items.
Supervision Requirements of an Assistant in the Private Practice Setting
Congress did not include any language regarding permanent changes to the supervision requirements of physical therapist assistants by physical therapists and occupational therapy assistants by occupational therapists.
Due to the public health emergency due to COVID-19, CMS has modified its definition of direct supervision so that direct supervision can be achieved by the therapist being available through virtual presence using real-time audio/video technology. The definition does not require the therapist to be on the premise and in the office suite.
This changed definition is in effect until December 31 of the year in which the public health emergency is declared over.
At this time, the PHE ends at the end of the day on Tuesday, April 11, 2023, unless extended further. This means CMS will continue to allow direct supervision through virtual presence through at least the end of the calendar year 2023.
Keep in mind that if your state practice act requires direct supervision, meaning you must be on the premise or in the office suite, then you must follow your state practice act since it is more stringent/restrictive than what CMS is allowing.
Medicare payments were due to decrease by an additional 4% in 2023 due to the mandatory PAYGO Act of 2010. The Consolidated Appropriations Act of 2023 delays PAYGO until 2025.
Rick Gawenda, PT, is the Founder and President of Gawenda Seminars & Consulting (GSC). GSC is offering a website membership subscription service and 12 upcoming webinars for outpatient rehab therapists with a savings of over $1,000. Visit https://gawendaseminars.com/subscription to view membership levels and to sign up as a member.
5 Strategies for Reducing Last-Minute Rehab Therapy Cancellations & No-Shows
Around 27% of appointments are likely to be missed, leading to lost revenue, poor productivity and negative patient outcomes. Learn to reduce this number!