Health care reform is swiftly moving providers and patients toward value-based payment and away from procedural-based, fee-for-service systems. To enable physical therapists and physical therapist assistants to be successful in this evolving environment, APTA has been actively pursuing payment alternatives as part of health care reform's triple aim of better care for individuals, lower costs, and better community health. The association's goal is to work with the federal government and payers to reform payment for outpatient physical therapist services to improve quality of care, recognize and promote the clinical judgment of the physical therapist, and provide policymakers and payers with an accurate payment system that ensures the integrity of medically necessary services. Below are areas of particular impact on PTs and PTAs.
The 2 familiar CPT codes for physical therapy evaluation and reevaluation will disappear beginning January 2017. In their place, PTs must begin using 3 new evaluation codes and a new reevaluation code. Now is the time to become familiar with them.
The CMS proposed physician fee schedule for 2017 introduced the 3 new CPT codes for physical therapy evaluation and 1 new code for reevaluation. The new evaluation codes reflect 3 levels of patient presentation: low-complexity (97161), moderate-complexity (97162), and high-complexity (97163), and will replace the current 97001 code. The new reevaluation code replaces the current 97002.
CMS failed to adopt tiered payment values for the 3 evaluation codes, as was recommended by the American Medical Association (AMA) Relative Update Committee. APTA's comments in response to the proposed rule reiterate its recommendations for stratified payment for different levels of complexity in physical therapist evaluations. Until the final rule is released in late October or early November, the association continues to voice these recommended changes to the proposal.
As part of APTA's longstanding efforts to pursue a new payment system that fairly reflects the expertise, skill, and responsibility of physical therapists in caring for their patients and clients, the association and its collaborators developed this 3-tiered system of CPT evaluation codes to replace the current single code that covered all physical therapist evaluations.
The new CPT evaluation and reevaluation codes are a step in the right direction toward overall payment reform, and APTA continues to work with AMA and other provider groups in seeing value-based payment evolve. For more information on APTA's efforts to reform payment, view our resources below or email firstname.lastname@example.org.