Physician Fee Schedule Effective January 1, 2019
CMS released the Physician Fee Schedule Final Rule in November 2018 with an effective date of January 1, 2019.
What you need to know
Functional Limitations (G Coding)
As of January 1st, entering of G codes on Medicare B claims is no longer required. However, we have instructed our rehab teams to continue to enter them for any Managed Care provider that requires them unless notified otherwise.
KX Modifier / Threshold
Although CMS repealed the therapy cap in 2018, CMS continues to require a KX modifier be applied to services over the threshold amounts, which for 2019 are as follows: $2040 for PT and ST combined, and $2040 for OT. Our billing exports will continue to include the KX modifier.
The fee schedule rates were increased by .11% in aggregate; reimbursement for some codes increased, some decreased. Please verify that your software has been updated accordingly.
New Assistant Modifiers
CMS created new modifiers to be entered on claims for Med B beginning Jan, 2020: CQ (for services performed by a Physical Therapy Assistant) and CO (for services performed by an Occupational Therapy Assistant). These modifiers distinguish rehab services that were performed by an assistant versus a registered therapist. This is NOT required at this time. CMS will notify us when the voluntary use of the codes will begin. In the meantime, rest assured that our software will provide the appropriate coding and come through on our billing export.