CMS Corrects Part B Fee Errors

Carl J. Pucci in Finance & Reimbursement

CMS has just announced that errors occurred in the 1/1/17 Part B Physician Fee Schedule. Seven of the eight new PT and OT codes were affected, causing underpayments to providers during the period 1/1/17 through 3/31/17. Past payments will only be corrected upon request. Members billing staff should review these price corrections to determine the amount underpaid and notify CMS accordingly.

The revised Part B Schedule is attached.

Below is the AHCA notification with further details.

The Centers for Medicare and Medicaid Services (CMS) recently announced there were errors in their Part B Physician Fee Schedule pricing files for seven of the eight new codes for physical therapy and occupational therapy evaluations that were introduced on January 1, 2017. These errors have resulted in underpayments for certain codes from January through March 2017. The CMS pricing file will be corrected on April 1, 2017 and applied retroactively.

Because CMS has instructed that corrections to past payments be corrected only upon request, Providers' therapy and billing staff should review these procedure price corrections to evaluate the scope and amount of underpayments. Medicare Administrative Contractors will not automatically correct claims already processed prior to April 1, rather, only those erroneously paid claims that providers bring to their attention.

Due to these changes, AHCA has posted an updated CY 2017 AHCA therapy pricing file on our website.

AHCA extends thanks for the efforts of Tony Marshall, President and CEO of the Georgia Health Care Association, for updating this data file. Detailed information related to how the CY 2017 AHCA therapy pricing file was constructed is posted on the Long Term Care Leader Blog.

Contact Dan Ciolek, AHCA Associate Vice President, Therapy Advocacy, with any questions.


Carl J. Pucci
Director, Finance & Reimbursement
518-462-4800 x36