2014 Medicare Part B Fee Schedule

The 2014 therapy fees for each CPT/HCPCS Code in each geographic area are now available courtesy of Tony Marshall with the Florida Health Care Association.  This Excel document has four worksheets containing the following information:

  1. The 2014 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality.
  2. The 2014 Medicare Part B MPPR Fee Schedule (MPPR) for “Always Therapy” Services (50% MPPR Factor Effective April 1, 2013).
  3. The 2014 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code.
  4. The 2014 Geographic Practice Cost Indices (GPCI) by Medicare Carrier and Locality.

The final Part B Fee Schedule amounts are calculated as follows:
(( A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and
(( A1 x B1) + ((A2 x B2) x (1-MPPR Factor)) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where:  
A1 = Physician Work RVU
A2 = Non-Facility Practice Expense RVU
A3 = Malpractice RVU
B1 = Work GPCI
B2 = Practice Expense GPCI
B3 = Malpractice GPCI
Conversion Factor = $35.8228
MPPR Factor = 50%

Please note that the fees reflect all changes included in the CY 2014 Medicare Physician Fee Schedule Final Rule published in the Federal Register on December 10, 2013 and subsequent technical corrections. The fee schedule also reflects legislation (Section 101 of the Pathway for SGR Reform Act of 2013) which provides for a one-half percent (0.5%) update to the CY 2014 Medicare Physician Fee Schedule and extends the 1.0 Work GPCI floor through March 31, 2014.
 
The final rule continues the multiple procedure payment reduction (MPPR) policy for “always therapy” services.  The MPPR policy required, effective April 1, 2013, a 50 percent reduction to be applied to the practice expense component of payment for the second and subsequent “always therapy” service(s) that are furnished to a single patient by a single provider on one date of service (including services furnished in different sessions or in different therapy disciplines).  The MPPR worksheet lists those “always therapy” services subject to the MPPR policy and the reduced fee payment amounts.

CPT codes 92521 (Evaluation of speech fluency), 92522 (Evaluate speech sound production), 92523 (Speech sound language comprehension) and 92524 (Behavioral and qualitative analysis of voice and resonance) are being added to the list of therapy codes. These codes replace CPT code 92506 (Speech/hearing evaluation) for CY 2014. Accordingly, CPT 92506 has been deleted. Also, like CPT 92506, these new codes are ‘‘always therapy’’ services subject to the MPPR for therapy services.

New CPT Code 97610 (Ultrasonic Wound Assessment) was also added for CY 2014. The new code will be contractor priced for CY 2014 as recommended by the AMA RUC. Although the code will be contractor priced, CMS has designated this service as a ‘‘sometimes therapy’’ service. Like other ‘‘sometimes therapy’’ codes, when a therapist furnishes this service all outpatient therapy policies apply. CPT Code 0183T (Wound ultrasound), which was also contractor priced was removed for CY 2014.

An overview of the Physician Fee Schedule Payment Policies may be found here and an overview of skilled nursing facility consolidated billing and annual updates can be found here.