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Reimbursement for Physical Therapists: 2021 May be the Year to Ditch Medicare & the Insurance Model for Cash-Only Clinics

OSTEOPRACTIC

On November 1, 2019, the Centers for Medicare & Medicaid Services (CMS) released the final 2020 Medicare physician fee schedule, which took effect January 1, 2020.1 In short, physical therapists are one of 26 healthcare specialties facing reimbursement reductions beginning in 2021.2 CMS specifically recommended cutting CPT (Current Procedural Terminology) codes that are billed for physical therapy services by 8%, but the exact per-code cuts have yet to be determined.2,3,4 Given that most private insurance companies set their reimbursement rates based on Medicare’s fee schedule, these cuts are particularly alarming.

The reimbursement cuts may feel like déjà vu, as CMS proposed a 26.5% cut in reimbursement rates in 2012, which Congress was able to prevent via the American Taxpayer Relief Act of 2012.5,6 Nevertheless, this eventually led to a 2% reduction in Medicare payments, which took effect on April 1, 2013.4 It also resulted in…

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Published by 1healthcare

Medical Billing, Medical Coding, Hospital Revenue Cycle management.

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