Physical therapist helps nursing home resident
Credit: Phynart Studio/Getty Images Plus

The day after the Centers for Medicare & Medicaid Services released the 2022 Physician Fee Schedule final rule, Industry stakeholders were searching for bright spots. Potentially “devastating” 15% pay cuts for work by therapy assistants overshadowed many other elements in the 2,414-page regulation.

Released late Tuesday afternoon, the rule confirmed the 15% payment cut for outpatient occupational and physical therapy services that are provided, in whole or in part, by an occupational or physical therapy assistant.

“With margins razor thin, this reduction literally means that often the cost for an assistant to provide services is often more than the amount of reimbursement,” Melissa Brown, COO of Gravity Healthcare Consulting, told McKnight’s Long-Term Care News on Wednesday. She added that the cut makes it “impossible” for providers to keep assistants employed. 

“This is, unfortunately, squelching the value of assistants and endangering their careers. We cannot advocate soon enough or too much against this unfounded cut against therapy for no reason other than needing to balance the budget,” she said. 

Brown also explained that the rule doesn’t address the fact that the 3.75% COVID bonus from the Consolidated Appropriations Act of 2021 is also disappearing, which will effectively yield “a significantly more than the 1% cut for PT, OT and [speech therapy] listed in the final rule.”

“When providers have even higher staffing costs than ever before, and ongoing COVID challenges and expenses, this additional reduction is not coming at the right time,” Brown warned. 

CMS in the final rule defines services furnished in whole or in part by PTAs or OTAs as those for which the assistant time exceeds a de minimis threshold. CMS revised the policy to allow a 15-minute timed service to be billed “without the CQ/CO modifier in cases with a PTA/OTA participates in providing care to a patient, independent from the PT/OT, but the PT/OT meets the Medicare but the PT/OT meets the Medicare billing requirements for the timed service on their own, without the minutes furnished by the PTA/OTA, by providing more than the 15-minute midpoint (that is, 8 minutes or more).” 

“Under this finalized policy, any minutes that the PTA/OTA furnishes in these scenarios would not matter for purposes of billing Medicare,” the agency stated. 

Brown described the adjustment as “positive” and said it will “help ease the reduction somewhat, though the impact is not significant.” 

Split (shared) visits 

CMS also refined its policies for split (or shared) for evaluation and management (E/M) visits to reflect the role of non-physician practitioners as members of the medical team. The agency now defines split (shared) E/M visits as those provided in a facility setting by a physician and NPP in the same group. The visit is billed by the physician or practitioner who provides the substantive portion of the visit. 

Geriatrician Michael Wasserman, M.D., applauded the move saying it “supports the use of a nurse practitioner and physician assistants” during the visits. AMDA — The Society for Post-Acute and Long-Term Care Medicine also supported the move, which it said “reinforces the concept of the interdisciplinary team approach to care.” 

Telehealth expansion

The final rule also confirmed that certain services added to the Medicare telehealth services list will remain there at least through Dec. 21, 2023, to give federal health officials additional time to evaluate whether they should be permanently retained. 

Additionally, the rule removes the geographic restrictions and added the beneficiary’s home as a permissible originating site for telehealth services when used for diagnosing, evaluation or treatment of mental disorders. The rule also requires that for these services there must be an in-person, non-telehealth service with the physician or practitioner within six months prior to the initial telehealth service. The federal government will be required to establish a frequency for subsequent in-person visits.

Both Wasserman and AMDA stressed the need to add nursing homes as a place of service for telehealth visits. 

“Telehealth visits were essential during the pandemic,” Wasserman said. “However, they’ve long been needed and will long be needed.” 

“We believe telehealth has been a vital tool for seeing patients in a timely manner in nursing facilities during the COVID-19 pandemic; it does not appear to have resulted in any trend toward lapses in the appropriateness of medical care in this setting, and it can continue to be after the public health emergency (PHE) is over,” AMDA previously wrote in comments to CMS. 

The new physician fee rule is scheduled to be officially published in the Federal Register Nov. 19. Full details can be found here in the Federal Register listing.