UPDATE: Senate Repeals the Cap (but with caveats)

UPDATED 2/9/18

The therapy cap was repealed on Friday, Feb 9 when President Trump signed the spending bill into law. We still have details coming in, but here’s what we know so far: 

  1. There is no cap. HOWEVER, there is still a manual medical review process at $3,000 which you will need to use the KX-modifier for. 
  2. PTA/COTA reimbursement costs will be cut by 15% in 2022. 

2/8/18, 5:00AM

On Wednesday Feb, 8th Democratic and Republican House and Senate Leaders announced a 2 year budget agreement. While details are murky at this point, there are some relevant Physical Therapy impacts we can report.

The deal includes Medicare therapy cap repeal.

However, we don’t yet know what additional provisions related to PT will be included in the final bill. While the spending increases have been negotiated and announced by members of Congress, there is yet no legislative text we can look to for details. Reports on the deal are currently sourcing: press releases and verbal interviews with the press. However we can report that a short term spending bill passed by the House on Tuesday included:

  1. Medicare therapy cap repeal. The KX modifier for medically necessary outpatient therapy continues with a manual medical review after  $3,000.
  2. Reimbursement cuts for PTA’s under medicare. Beginning in 2022 PTA (as well as OTA) reimbursement would be cut by 15%. Per a CBO report from February 6th, 1.2 billion of the 6.45 billion cost to repeal the therapy cap would be offset by the reimbursement changes.
  3. Changes to home health would include: extension of the home health rural add on through 2022, However the bill changes the home health unit of payment from 60 days to 30 days starting in 2020, and would reduce market basket update by 1.4%.

We don’t know if these provisions will be included in the final budget legislation passed by the Senate and House, but given the budgetary power of the House of Representatives it seems entirely possible. Keep your legislators on the phone, and stay tuned to Talus for updates, expect greater clarity by the end of the week.