Year-end Appropriations Bill Provides Some Relief from Drastic Fee Schedule Cuts

Year-end Appropriations Bill Provides Some Relief from Drastic Fee Schedule Cuts

On December 21st, Congress passed the Consolidated Appropriations Act of 2021, a bipartisan omnibus and COVID-19 relief package that provides some relief from the 9% cut to therapy reimbursement via the Medicare Physician Fee Schedule finalized by CMS earlier this month in the 2021 Medicare Physician Fee Schedule Final Rule. The President is expected to sign the bill this week.

The bill includes several provisions that partially mitigate the cuts anticipated by the more than three dozen provider types impacted negatively by the fee schedule budget neutrality requirement:

        • Blocks the new add-on fee schedule complexity code, G2211 (formerly GPC1X) for three years – projected savings to the fee schedule are $3 billion
        • Injects another $3 billion of new money into the fee schedule in 2021 (for one year only), resulting in a 3.75% increase to the conversion factor for all services paid on the fee schedule (this is a 3.75% increase to the CF finalized in the 2021 final rule – $32.41)
        • Delays the resumption of sequestration (2% cuts to all Medicare fee for service payment) for another 3 months (sequestration was set to resume 1/1/2021)
        • Extends the work 1.0 geographic practice cost index floor through 12/31/2023

Although the full impact of these provisions is not yet known, industry associations estimate outpatient therapy services will see an overall decrease of 3.6% in 2021, versus the anticipated 9% cut outlined in the final rule, an improvement certainly, but not the outcome the thousands of therapists, patients, and other stakeholders advocated for.

Holly Hester

Holly Hester is Casamba’s Senior Vice President of Compliance & Education, as well as the Compliance Officer. She provides regulatory guidance and interpretation, clinical programming and content development, education and training steerage, and compliance support for the company. As a physical therapist for more than 20 years, Holly has multi-venue clinical and management experience, giving her a unique perspective on the integration of compliance and training with therapy service delivery and clinical practice.
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