#FighttheCut: Medicare Physician Fee Schedule Cuts To Therapy Effective Jan 1 2021

December 1st, CMS released the CY 2021 Medicare Physician Fee Schedule Final Rule. In this Final Rule, CMS is finalizing its proposals to update payment policies, payment rates, telehealth policies, and quality provisions for services furnished under the PFS on or after January 1, 2021.


Payment Impact

Within this policy, CMS has increased the value of the Evaluation and Management (E/M) codes (potentially including PT/OT and ST Part B evaluation codes). To offset this increase, other code values had to be lowered to achieve budget neutrality requirements. Included in that decrease are the PT/OT and ST treatment codes. Projected impacts being a 9% overall reduction to PT/OT and 6% reduction for ST.


Potential Mitigation Strategies: (QRM is here to help)

  • Advocacy and legislative offset of cuts

  • Ensure access to care through all available options including extended telehealth and remote service offerings, preserving reimbursement

  • Contain costs through efficiencies, appropriate rehab staffing levels, utilization of rehab team members at the top of their skill level


#FighttheCut - Advocacy Opportunity:

Associations are gathering to push through legislative action to offset this cut by Jan 1. Please take this opportunity (2 min or less) to utilize the link below provided by NASL to reach your Senators. This letter urges them to take action to preserve reimbursement for the care of our most severely impacted population as a result of COVID isolation and recovery difficulties.


Additional Information:

For a fact sheet on the CY 2021 Physician Fee Schedule Final Rule, please visit: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1


For a fact sheet on the CY 2021 Quality Payment Program final rule, please visit: https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1207/2021%20QPP%20Final%20Rule%20Resources.zip


To view the CY 2021 Physician Fee Schedule and Quality Payment Program final rule, please visit: https://www.cms.gov/files/document/12120-pfs-final-rule.pdf


Let's Get to the Point:

Please help preserve reimbursement for and access to critical care for our most fragile and highest impacted COVID population.
QRM is here to help. Please reach out if we can support you in any way.