Advocacy & News

Medicare Part B and Outpatient Issues

Inpatient rehabilitation hospitals or units also provide outpatient therapy services to help improve and restore function to patients after an illness or injury. Outpatient therapy services include physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP) services and others. IRH/Us furnish outpatient therapy services in multiple settings including hospital outpatient departments, outpatient rehabilitation clinics, and comprehensive outpatient rehabilitation facilities (CORFs). AMRPA is active in providing feedback to Federal officials on the importance of the Physician Fee Schedule and Quality Payment Program that reimburses therapists for outpatient therapy services.

Recent AMRPA Comment Letters:

Physician Payments
The Physician Fee Schedule (part of Medicare Part B) reimburses Physicians for many visits that take place in the IRH/U and outpatient setting. AMRPA is active in monitoring proposals that would alter payments to rehabilitation physicians, and also works with other stakeholders to develop responses to any proposed changes. Most recently, AMRPA opposed CMS’ proposal to change the way Medicare reimburses Evaluation and Management (E/M) visits due to the risk of jeopardizing access to treatment for patients with complex conditions. You can read AMRPA’s response to that proposal in the 2018 AMRPA Comment Letter.

Therapy Caps
In 2018, Congress eliminated the limits on how much Medicare pays for therapy services in one calendar year (also called "therapy caps" or "therapy cap limits"). AMRPA supported an end to the therapy caps and it was a significant win for the most vulnerable Medicare patients.

In order for PT, OT, and SLP services to be covered by Medicare, Medicare still requires a therapist or therapy provider to confirm that the therapy services and medically necessary and reasonable when they reach certain limits.

CMS Links:
Quality Payment Program 
Physician Fee Schedule