Welcome to the New year and New Part B Rules! From the Final Physician Fee Schedule, we have identified the top five therapy related billing reminders effective as of January 1, 2019.
1. Functional Limitations (G Codes)
- For patients under the Medicare Part B payer, with dates of services on or after January 1, 2019, providers will no longer need to report G codes on their claims.
- NOTE: Managed Medicare Part B payers have not yet reported a change in practice. Therefore, our software will continue to remind our therapists to enter G Code information for these other payers. In addition, we will include this information on our monthly billing files.
- Related to this, CMS has shared that IF a G code is 'accidentally' placed on a claim for a patient under the Medicare Part B payer, this will not disrupt their system. Instead, they will just 'ignore' the G
2. KX Modifier and the Therapy Cap
- Yes, the therapy cap was repealed with the Bipartisan Budget Act of 2018. However, CMS finalized its proposal to continue requiring the KX modifier to be applied to claims over the therapy cap amount. For FY 2019, the KX modifier threshold is $2,040 for OT and $2,040 for PT and SLP combined.
- As in the past, we will use our software to trigger the correct placement of the KX modifier with the end of month billing files.
3. Targeted Medical Review
- CMS finalized their proposal for the continuation of the targeted medical review (MR) process at a threshold of $3,000 in service claims. This is $3,000 for OT and $3,000 for PT and SLP combined.
4. Rates
- The entire fee schedule increased by .11% starting January 1, 2019. This includes the Medicare Part B rates for Rehab Therapy CPT codes. Please verify your rates have been updated in your facility software before sending January charges to Medicare for payment.
- NOTE: 18 of the top 23 rehab therapy codes (by use) received very slight increases in payment. Five others received decreases in payment.
5. New Assistant Modifiers not required until 01/01/2020
- The newly created' modifiers for services provided by PTAs and OTAs will be attached beginning 1/1/2020. For PTAs, this will be a 'CQ' modifier and for OTAs this will be a 'CO' modifier. These modifiers will be reported in addition to, or alongside, the GP or GO modifier on a claim line and not in replacement of the GP or GO.
- This modifier is only used when the PTA or OTA provides more than 10% of the line item service.
- The short story here is our software will be set to track and record these modifiers and we will include this with your end of month billing file.
As always, any of us here at Trinity Rehab Services are available to answer any questions or to discuss how we might work together in the future. We offer everything from full contract therapy services to specific compliance audits or IT support services.Contact us to learn more. We'd love to hear from you.