Legislative Update

Legislative update on: 
  • Medicare Fee Schedule
  • Fair Copay
  • Dry Needling
  • Licensure Compact
  • Disability Placards

Medicare Fee Schedule:

Final rule released on November 1, 2018

  • Conversion factor – giving an increase of 0.14% to Medicare payment for 2019
  • Therapy Threshold dollar amount is increased to $2040.00
  • Targeted medical review amount remains $3000.00 for PT/SLP
  • Functional limitation reporting is planned to end on January 1, 2019 for traditional Medicare plans but Medicare advantage plans have the option to continue if desired.
  • PTA modifiers must now be added to the bill if services were provided in whole or in part by a PTA.  If a PTA provides more than 10% of the service the modifier must be added to the bill.  These modifiers will be required starting January 1, 2020. 

            MIPS – Non-Institutional Settings only

  • Private practices only initially -  Beginning January 1, 2019 PTs will be included in MIPS (Merit-Based Incentive Payment system) and be required to collect and submit data for an annual score:

                        Criteria are:

    • Quality
    • Promoting Interoperability – EMR use is one example (part of meaningful use)
    • Clinical Practice Improvement activities
    • Cost

            PTs will be assessed in 2 of the 4 areas in 2019

  • Quality
  • Clinical Practice Improvement activities

            Designed to reduce variation in practice.

Need to meet 3 Criteria be required to participate:

  1. More than $90,000 in annual medicare allowed charges
  2. Treat 200 or more Part B enrolled  individuals
  3. And provide 200 covered professional services to part B enrollees (200 visits)


Has incentives and penalties starting in 2019 and increasing every year.

Penalties or incentives will be assessed starting in 2021 payment year. 

Practices can chose to belong to advanced payments models to avoid MIPS. 

APTA has info and a page dedicated to MIPS


Fair Copay legislation:

            Many states have enacted Fair copay legislation.  It is The VPTA's intent to propose legislation during the 2020 legislative season.  This Planned  legislation's goal will be to create parity between PT's and Primary Care Copays. 


Dry Needling:

            Currently the Regulation is sitting on the Governor's desk and has passed all the requirements to be signed.  No date on signature but hopefully soon.  Currently we can perform TDN without specific regulation. 


Licensure Compact:

            Will allow PT's to apply for privilege to practice in states other than their home license state through application to a compact board.  This is currently in on the Governor's desk as well to determine if he will submit it with his legislative package this year.  If he carries it we wills support.  If not we will assist the board in putting legislation forth.  Should know something by mid December.


Disability placards:

            The VPTA is seeking to add PT's to the list of individuals who can issue Disability placards for parking.  There is currently no time frame for legislative action. 



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