CMS Rulings for 2020

Author: Paul Singh

What Therapists Need to Know

As we begin the new calendar year, there are some new Centers for Medicare and Medicaid Services (CMS) rulings that therapists should know about.

2020 Conversion Factor:  Therapists are seeing a nearly flat conversion factor this year.  With the budget neutrality adjustment to account for changes in relative value units (RVUs), the finalized CY 2020 Physician Fee Schedule (PFS) conversion factor is 36.09, just a slight increase of 0.05 above the CY 2019 PFS conversion factor of 36.04.

2020 Annual Therapy Threshold Dollar Amount (also called the KX modifier thresholds):  If a patient’s therapy costs reach a certain amount, Medicare requires the therapist to confirm that the therapy is medically necessary.  In 2020, the Medicare therapy thresholds are as follows:

  • $2,080 for physical therapy (PT) and speech-language pathology (SLP) services combined.
  • $2,080 for occupational therapy (OT) services.

Please note, services exceeding $3,000 annually for PT and SLP services combined, or OT services may be subject to additional review.

New PTA and OTA Modifiers:  Therapists need to be aware of the CMS rule that requires new PTA and OTA modifiers.  This rule went into place at the beginning of 2020.

Basically, the rule involves when a therapy assistant provides a service that is “in whole or in part”.  The service line on the Medicare B claim must now include one of the following two payment modifiers.

  • CQ (for PTAs)
  • CO (for OTAs and COTAs)

For a more detailed look at these new modifiers, please read our New PTA and OTA Modifiers article.

While the rulings may seem simple enough, the reality is that there are always exceptions to these rules and the underlying complexity of the rules can often be confusing.  Putting into practice some of the CMS rules can sometimes lead to headaches and aggravation. However, it doesn’t have to be that way.

StrataPT always has your back.  We can answer the most difficult questions and we provide solutions that fit into your physical therapy business model.  We offer revenue cycle management for outpatient physical and occupational therapy practices, large or small. Offering a true all-in-one solution is why we are the leading billing, insurance, credentialing and benefit services company in the industry

Contact us today and request a demo today!  Our friendly team members can show you how we can provide your business with an unparalled level of support and transparency.

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