Medicare’s 2019 Physician Fee Schedule

December 26, 2018
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Medicare’s 2019 physician fee schedule changes affecting PT/OT include:

KX Modifier: Although the therapy cap was repealed as of 1/1/18, the KX modifier is still required. For 2019, the KX modifier will need to be added to claims above $2,040 for PT/SP combined and for OT claims above $2,040 (which is an increase from the 2018 amount of $2,010).

Functional Limitations Reporting (G codes): G codes will not be required for dates of service on and after 1/1/19. This applies to patients whose therapy started in 2018 and continues into 2019. If you have patients covered by a Medicare Advantage plan that requires G codes, you will need to check with that plan as to whether it will continue to require G codes.

Merit-Based Incentive Payment System (commonly known as “MIPS”): PTs and OTs are added to the list of providers required to report MIPS measures starting in 2019. For PTs and OTs, MIPS will be similar to PQRS.

PTA/COTA Services: The finalized rules include a discussion regarding new modifiers for PTA/COTA services that will be required in 2020. Nothing needs to be done in 2019 in this regard.

Telehealth: The finalized rules include new allowances for telehealth. However, PTs and OTs are not included in the listed of providers who Medicare will pay for telehealth services during 2019.