2013 Part B Fee Schedule

This information is being made available to VHCA members through the generosity of Tony Marshall with the Florida Health Care Association.

The 2013 therapy fees for each CPT/HCPCS Code in each geographic area are provided in the linked Excel spreadsheetThis document has four worksheets containing the following information:

  1. The 2013 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality.
  2. The 2013 Medicare Part B MPPR Fee Schedule (MPPR) for “Always Therapy” Services (25% MPPR Factor for January 1, 2013 through March 31, 2013).
  3. The 2013 Medicare Part B MPPR Fee Schedule (MPPR 04012013) for “Always Therapy” Services (50% MPPR Factor Effective April 1, 2013).
  4. The 2013 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code.
  5. The 2013 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 = $34.0230
MPPR Factor = 25% (January 1, 2013 through March 31, 2013)
MPPR Factor = 50% (Effective April 1, 2013)

Please note that the fees reflect all changes included in the CY 2013 Medicare Physician Fee Schedule Final Rule published in the Federal Register on November 16, 2012 and subsequent technical corrections. The fee schedule also reflects legislation (the American Taxpayer Relief Act of 2012) which provides for a zero percent (0%) update to the CY 2013 Medicare Physician Fee Schedule and extends the 1.0 Work GPCI floor through December 31, 2013.  

The final rule continues the multiple procedure payment reduction (MPPR) policy for “always therapy” services.  The MPPR policy required a 25 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).  Effective April 1, 2013, the American Taxpayer Relief Act of 2012 requires a 50 percent reduction be applied. The MPPR worksheet lists those “always therapy” services subject to the MPPR policy and the reduced fee payment amounts.

The American Taxpayer Relief Act of 2012 extends the exceptions process for outpatient therapy caps through December 31, 2013 ($1,900 cap for physical therapy and speech language pathology services combined and a separate $1,900 cap for occupational therapy) and extends the medical review process when a beneficiary has reached a dollar aggregate threshold amount ($3,700 for physical therapy and speech language pathology services combined and a separate $3,700 for occupational therapy).

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.