Biofeedback and Dry Needling Coding Update, Medicare Physician Fee Schedule

Practice & Advocacy,

Reported by Gail Zitterkopf, PT, DPT, Federal Affairs Chair of the Academy of Pelvic Health Physical Therapy

CPT code 90911 (biofeedback training) was replaced with 2 codes: 90912, biofeedback training, initial 15 minutes of one-on-one patient contact; and 90913, biofeedback training, each additional 15 minutes of one-on-one patient contact. CMS clarified these as “sometimes therapy” procedures.

Dry Needling

The final rule adds 2 dry needling codes (20560, needle insertions without injections in 1-2 muscles, and 20561, needle insertions without injections in 3 or more muscles), but CMS classified the codes as noncovered Medicare services unless a national coverage determination says otherwise. If the codes were covered, CMS believes they should be considered as “sometimes therapy” procedures rather than “always therapy.”

**Trigger point dry needling codes (20560 and 20561): Although CMS finalized the work and practice expense RVUs for these codes, CMS stated in the final rule that these dry needling codes are non-covered Medicare services in 2020.

2020 Physician Fee Schedule

On November 1, 2019, the Centers for Medicare and Medicaid Services released the 2020 Physician Fee Schedule/Quality Payment Program final rule. The rule includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule effective on or after January 1, 2020.

Within the rule, among numerous other policies, CMS finalized a policy regarding application of the new PTA and OTA modifiers on outpatient therapy claims beginning in 2020. As you may know, beginning January 1, 2020, outpatient therapy providers are required to affix a modifier the claim to denote when outpatient therapy is furnished in whole or part by PTA or OTA. Then, beginning on January 1, 2022, payment for outpatient therapy services provided by PTA or OTA will be at 85% of the physician fee schedule. In response to APTA’s advocacy efforts, CMS adopted all of APTA’s recommended improvements to the policy. Scenarios outlining how to use the new modifiers will be posted to the CMS website in the near future.

CMS also finalized its proposal to adopt increases to the values of the office/outpatient E/M codes in 2021, which requires CMS to make redistributive negative adjustments across specialties to maintain budget neutrality under the Medicare physician fee schedule. Under the plan, physical therapy/occupational therapy could see reductions to CPT code valuations that may result in an estimated 8% decrease in payment in 2021. In total, 36 specialties are facing reimbursement reductions in 2021.

Other policies to be aware of:

  • CY 2020 KX modifier threshold amount: $2,080 for PT and SLP services combined and $2,080 for OT services.
  • CMS adopted new regulations that permit CMS to revoke or deny a physician or other eligible professional’s Medicare enrollment when such professional’s actions result in patient harm.
  • CMS finalized changes to the PT/OT specialty measure set for MIPS in 2020.
  • CMS will continue to reweight the Promoting Interoperability category for physical therapists in 2020.

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