The final 2013 Medicare physician fee schedule rule has been released on November 1st, 2012. This policy and payment update sets the Medicare therapy cap amount for outpatient therapy services and payment. According to the American Physical Therapy Association (APTA), this fee schedule established the 2013 therapy cap exception at $1,900 but this exception will only last till December 31, 2012 unless the Congress extends it. In addition, the APTA notes that this rule also “includes a 26.5% reduction to Medicare payment rates for physicians, physical therapists, and other professionals due to the flawed sustainable growth rate formula.” They also mentioned that this reduction can be avoided if the Congress acts by the end of the year (as it repeatedly has done since 2003) and change the growth rate formula such that the “aggregate impact on payment for outpatient physical therapy would be a positive 4% in 2013.”
The CMS implemented multiple changes within the fee schedule rule which include but are not limited to new functional status codes for physical therapists and updates the Physician Quality Reporting System (PQRS). To view a brief summary of the 2013 rule, please visit AAFP’s summary of the 2013 Medicare physician fee schedule rule. To view the complete legal documentation, please visit the Office of the Federal Register and look for the Adobe document under CENTERS FOR MEDICARE & MEDICAID SERVICES.