Is Your Medicare Documentation Ready for 2020?
2020 is almost here and so are the updates to Medicare’s CPT codes, modifiers, deductibles and payments.
Below are major updates that physical and occupational therapists should be aware of heading into the New Year:
Medicare Part B Deductible
$198.00 in 2020. This is a $13 increase from last year. The patient will be responsible for this portion in addition to the 20% coinsurance. However, if the patient has a secondary insurance, it may also pick up the deductible. It is important to verify this before a patient is seen at the beginning of the year.
New CPT Codes for 2020
90912
90913
97129
97130
Deleted CPT and HCPCS Codes in 2020
64550
95831
95832
95833
95834
G0515
G8978 through G8999; G9158 through G9176; and G9186
New PTA/OTA Medicare Modifiers for Medicare Claims
CQ Modifier: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant.
CO Modifier: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant.
It is important to note that starting in 2022, if the PTA or OTA provides 10% or more of the treatment session, CPT codes that have a CQ or CO Modifier will be paid at 85% the rate of what a PT or OT would receive for those services. This delay in payment reduction was a major policy win in 2019 but it is important to continue to pressure CMS to delay that increase indefinitely.
Under the Medicare law, the CQ and CO modifiers do not apply to Medicare Advantage plans. However - you should still have your verification team ask each insurance company if they are independently requiring the additional modifiers or will be in the future.
Have questions about these updates? Email us at hello@lincolnrs.com to see how LRS can help.
