CMS Proposed Rule Revisions for Calendar Year 2020: Part Three

The 85% Ruling

One of the CMS proposed rulings would go into effect on January 1st, 2022.  Any claim provided in whole or in part by a PTA or OTA, beginning on or after that date, will be paid at 85 percent of the otherwise applicable payment amount for the service.

This would directly affect physical and occupational therapists in private practice.  This would not be applicable to outpatient physical therapy or occupational therapy services furnished by critical access hospitals (CAHs).

It is important to note that the CQ or CO modifier is to be applied alongside the corresponding GP or GO therapy modifier.  Starting in January of 2020, claims that are missing the CQ or CO modifier will be rejected/returned to the therapist or therapy provider so they can correct the claim and resubmit it for processing.

How will the proposed 85% ruling affect your physical therapy billing procedures?  StrataPT has answers you need for the upcoming changes in the CMS, along with the service and attention your practice deserves.
Please contact a friendly StrataPT team member today at (866) 281-7636 to find our more information about their physical therapy billing solutions.  You can also contact StrataPT via their website.

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