Home Health & Hospice Week

Payments for outpatient therapy will increase Jan. 1.

Without the therapy cap expiration drama this December, the Medicare Physician fee schedule Final Rule may seem like a breeze to home health agencies that furnish Part B outpatient therapy. But don't brush it off too quickly, since there's an important batch of changes for outpatient therapy in 2009.

First off: The new therapy cap will be $1,840 for occupational therapy and $1,840 for physical therapy and speech-language pathology combined. Those caps apply only to outpatient therapy offered under Part B, not to therapy services furnished under a home health plan of care.

Thanks to the Medicare Improvements for Patients and Providers Act of 2008, you're still able to use the exceptions process until Jan. 1, 2010. As far as individual code values for 2009, however, you'll see some variance.

The MIPPA legislation ensured that providers wouldn't see a 10.1 percent cut to the conversion factor. The MPFS Final Rule confirmed this and declared a 1.1 percent increase to the conversion factor.

On the upside: "Occupational therapy [and physical therapy] codes will see a 3 percent aggregate increase for 2009," says Sharmila Sandhu with the American Occupational Therapy Asso-ciation. "But keep in mind that this is an average -- some code values have increased, while others may have decreased, so be sure to check the values of each individual code that you bill."

To view the 2009 values of the 97000-series codes, see page 70136 of the Federal Register, Vol. 73, No. 224 for Wed., Nov. 19, 2008, at http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf.

Don't miss: The Centers for Medicare & Medicaid Services decided to keep bundled the new CPT code for canalith repositioning, 95992 (Cana-lith repositioning procedure(s) [e.g. Epley maneuver, Semont maneuver], per day). But there may be a chance for physical and occupational therapists to get reimbursed separately for this code in 2009, says Gayle Lee with the American Physical Therapy Association. "CMS does do quarterly updates, so it's possible the code could be updated next quarter, but we'll have to wait and see."

SLP News: The MPFS Final Rule confirms that SLPs will have Private Practice billing status beginning July 1, 2009. "CMS has said it will provide further manual guidance, which we'll probably see in the spring," says Ingrida Lusis of the American Speech-Language-Hearing Associa-tion. Meanwhile, SLPs should be getting their NPIs and taking care of Medicare enrollment paperwork, she says.