American Speech-Language-Hearing Association
December 30, 2010

CMS Releases Updated 2011 Medicare Physician Fee Schedule

On Wednesday, December 29, 2010, CMS released Transmittal 828 (Pub 100-20), Emergency Update to the CY 2011 Medicare Physician Fee Schedule (MPFS) Database [PDF]. The revision for the MPFS follows the enactment of two major laws: (1) the Physician Payment and Therapy Relief Act of 2010, signed by President Obama on November 30, 2010, and (2) the Medicare and Medicaid Extenders Act of 2011, signed by the President on December 15, 2010. The CMS publication includes a new calendar year conversion factor (CF) of $33.9764, an increase of 33.1% from the initially published 2011 CF.

The relative value unit (RVU) files were also updated and the speech-language evaluation (CPT 92506) practice expense RVU was raised from 2.26 to 4.01. The new total RVU multiplied by the revised CF brings the national fee from $80.90 to $167.16 (practitioners need to determine their local rates). In November 2010, ASHA discovered that CMS had lowered the 2011 practice expense RVU for 92506 in error. ASHA contacted CMS and they agreed that a correction was necessary.

The Physician Payment and Therapy Relief Act of 2010 (PPTRA) requires a new reduced therapy fee schedule amount (20% reduction on the practice expense (PE) component of payment) be incorporated into the MPFS payment file. Per this Act, CMS will apply the CY 2011 MPFS Final Rule policy of a 25% multiple procedure payment reduction (MPPR) on the PE component of payment for therapy services furnished in hospital outpatient departments and other facility settings. A 20% reduction will apply to therapy services furnished in clinicians' offices and other settings that are paid under section 1848 of the Act. The daily MPPR does not apply to the therapy procedure with the highest practice expense. This change is detailed in recently released CR 7050, Transmittal 826. The PPTRA did not make the therapy MPPR budget neutral under the PFS and, therefore, the redistribution to the PE RVUs for other services that would otherwise have occurred will not take place.

The transmittal reiterates the extension of the exceptions process for Medicare therapy caps through December 31, 2011, as signed into law by President Obama on December 15, 2010, under the Medicare and Medicaid Extenders Act of 2010. Speech-language pathologists can continue to submit claims with the KX modifier, when services are medically necessary.

The updated 2011 Medicare Physician Fee Schedule for Audiologists and the 2011 Medicare Physician Fee Schedule for Speech-Language Pathologists are found on ASHA's Medicare Fee Schedule Web page.

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