The information provided in this memo covers the periods of January 1, 2012 through February 29, 2012.
2012 Medicare Part B Fee Schedules – Effective January 1, 2012 through February 29, 2012
The 2012 therapy fees for each CPT/HCPCS Code in each geographic area are provided in the attached Excel spreadsheet. This document has four worksheets containing the following information:
- The 2012 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality.
- The 2012 Medicare Part B MPPR Fee Schedule (MPPR) for “Always Therapy” Services.
- The 2012 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code.
- The 2012 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 .75) + (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 = $34.0376
MPPR Factor = 25%
Please note that the fees reflect all changes included in the 2012 Medicare Physician Fee Schedule Final Rule published in the Federal Register on November 28, 2011 and corrections published in the Federal Register on January 4, 2012. The fee schedule also reflects legislation (the Temporary Payroll Tax Cut Continuation Act of 2011) which provides for a zero percent (0%) update to the 2012 Medicare Physician Fee Schedule and extends the 1.0 Work GPCI floor for two months through February 29, 2012.
The final rule removed HCPCS 96110, Developmental test, lim, as an active code for Part B therapy services.
The final rule continues the multiple procedure payment reduction (MPPR) policy for “always therapy” services that were effective for CY 2011. The MPPR policy required 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.