2011 Medicare Rates, Policies Finalized In late December the Centers for Medicare and Medicaid Services (CMS) released 2011 rates for the Medicare Physician Fee Scale (MPFS) that incorporate a new conversion factor, revise relative value units for some procedures, and reduce payments for multiple same-day procedures. The “Emergency Update to the CY 2011 Medicare Physician ... Policy Analysis
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Policy Analysis  |   February 01, 2011
2011 Medicare Rates, Policies Finalized
Author Notes
  • Steven White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.
    Steven White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   February 01, 2011
2011 Medicare Rates, Policies Finalized
The ASHA Leader, February 2011, Vol. 16, 3. doi:10.1044/leader.PA1.16022011.3
The ASHA Leader, February 2011, Vol. 16, 3. doi:10.1044/leader.PA1.16022011.3
In late December the Centers for Medicare and Medicaid Services (CMS) released 2011 rates for the Medicare Physician Fee Scale (MPFS) that incorporate a new conversion factor, revise relative value units for some procedures, and reduce payments for multiple same-day procedures.
The “Emergency Update to the CY 2011 Medicare Physician Fee Schedule Database” [Transmittal 828 (Pub 100-20)], includes MPFS revisions that reflect two new laws: the Physician Payment and Therapy Relief Act of 2010 and the Medicare and Medicaid Extenders Act of 2011.
The policies outlined in the transmittal include:
  • A 2011 conversion factor of $33.9764, an increase of 33.1% from the initially published 2011 figure.

  • Updated relative value unit (RVU) files, including the practice expense RVU for speech-language evaluation, which was raised from 2.26 to 4.01. With the new RVUs and revised conversion factor, the national fee increases from $80.90 to $167.16 (practitioners need to determine their local rates). CMS corrected a lower RVU amount for the procedure after ASHA called attention to the error.

  • A new Multiple Procedure Payment Reduction (MPPR) policy that reduces reimbursement for multiple procedures provided to a single patient on the same day.

  • Continued extension of the exceptions process for Medicare therapy caps through Dec. 31, 2011. When submitting claims for medically necessary services beyond the cap, speech-language pathologists may submit claims with the “KX” modifier. The 2011 cap for combined speech-language and physical therapy services is $1,870.

Multiple Procedure Payment Reduction
MPPR reduces payment for second and subsequent speech-language pathology, occupational therapy, or physical therapy procedures provided to the same patient in one day:
  • For procedures provided in the clinician’s office and other settings described in the Physician Payment and Therapy Relief Act, the transmittal requires a 20% reduction in the practice expense component of the payment.

  • For procedures provided in hospital outpatient departments and other facility settings, the transmittal requires a 25% reduction in the practice expense component of the payment.

Full payment will be made for the service or unit with the highest practice expense value; payment reductions will apply to any other additional speech-language, physical therapy, or occupational therapy procedures performed on the same day.
Go online for the updated 2011 fee schedules for audiologists and speech-language pathologists. For answers to specific questions, contact reimbursement@asha.org.
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February 2011
Volume 16, Issue 2