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Medicare >> Memorandum
To: AHCA Members
From: William W. Hartung
Subject: 2011 Medicare Part B Fee Schedules (January 1, 2011 through December 31, 2011)
Date: 1/20/2011

The information provided in this memo covers the periods of January 1, 2011 through December 31, 2011.

2011 Medicare Part B Fee Schedules – Effective January 1, 2011 through December 31, 2011

The January 1, 2011 therapy fees for each CPT/HCPCS in each geographic area are provided in Excel format.  This document has four worksheets containing the following information:

  1. The 2011 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality.
  2. The 2011 Medicare Part B Fee Schedule (Part B Fees) for those “Always Therapy” services subject to the Multiple Procedure Payment Reduction (MPPR) Policy for Outpatient Rehabilitation for each Carrier and Locality.
  3. The 2011 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code.
  4. The 2011 Geographic Practice Cost Indices (GPCI) by Medicare Carrier and Locality.

The final Part B Fee Schedule amounts are calculated as follows:

(A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor (Part B Fees), and

(A1 x B1) + ((A2 x B2) x .8) + (A3 x B3)) x Conversion Factor (MPPR Part B Fees), where:  

A1 = Physician Work RVU
A2 = Non-Facility Practice Expense RVU
A3 = Malpractice RVU
B1 = Work GPCI
B2 = Practice Expense GPCI
B3 = Malpractice GPCI

Conversion Factor = $33.9764

MPPR Factor = 25%

Please note that the fees reflect all changes included in the 2011 Medicare Physician Fee Schedule Final Rule published in the Federal Register on November 29, 2010 and corrections expected to be published in the Federal Register on January 11, 2011 (the regulation, CMS-1503-CN2, was posted on December 30, 2010).  The fee schedule also reflects legislation signed by the President (the Physician Payment and Therapy Relief Act of 2010 and the Medicare and Medicaid Extenders Act of 2010) which provides for revisions to the multiple procedure payment reduction percentage and for a zero percent (0%) update to the 2011 Medicare Physician Fee Schedule through December 31, 2011.  A notice will be published in the Federal Register regarding these changes.. 

The final rule re-established HCPCS 95992, Canalith repositioning proc, as an active code for Part B therapy services.  (This code was originally established as a bundled code in CY 2009 and was not recognized for Medicare payment in CY 2010.)

Most importantly, the final rule adopted a multiple procedure payment reduction (MPPR) policy for “always therapy” services effective for CY 2011.  The MPPR policy requires a 25 percent reduction to be applied to the practice expense component of payment for the second and subsequent “always therapy” service(s) that are furnished to a single patient by a single provider on one date of service (including services furnished in different sessions or in different therapy disciplines).  The MPPR worksheet lists those “always therapy” services subject to the MPPR policy and the reduced fee payment amount.

An overview of the Physician Fee Schedule Payment Policies may be found at http://www.cms.hhs.gov/PhysicianFeeSched/ and an overview of skilled nursing facility consolidated billing and annual updates can be found at http://www.cms.hhs.gov/SNFConsolidatedBilling/

Thank you to Mr. Tony Marshall of the Florida Health Care Association for providing these calculations.

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