Medicare Threshold (formerly Cap) Alerts (Medicare Fee Schedule)

Easily monitor Medicare patients with Medicare Threshold Alerts, which are specific to your clinic's regional location and facility type. Follow the steps below to set up and enable Medicare Threshold Alerts. You must be a clinic administrator to complete these setup steps.

The Medicare Fee Schedule has been updated to reflect the changes for 2023. The conversion factor has been updated to $33.06 and RVU/GPCI values are also up to date for 2023. These updates will automatically be applied to all visits starting January 1, 2023, and the Medicare Threshold used amounts will display accurately.

Sync to the Correct Medicare Fee Schedule

Click on your clinic name to open the dropdown menu and then select Clinic Settings.
In the Medicare Fee Schedule section, choose your clinic's location using the Select a Regional Location drop-down. Also, indicate the Facility Type as either Non-Institutional or Institutional.
Save Settings at the bottom of the page. If you have multiple clinics, you will need to complete these steps for each additional clinic.

Turn on Medicare Threshold Alert System

A clinic administrator can quickly enable the Medicare Allowable Fee Schedule or Medicare Threshold Alerts for any clinic location.

Select your clinic name to open the drop-down menu and then select Clinic Settings.
In the Medicare Threshold Alerts System section, you can turn on the entire system or just specific alerts.
Save Settings at the bottom of the page. If you have multiple clinics, you will need to complete these steps for each additional clinic.

Turn off Medicare Threshold Alert System

A clinic administrator can quickly disable the Medicare Allowable Fee Schedule or Medicare Threshold Alerts for any clinic location.

Select your clinic name to open the drop-down menu and then select Clinic Settings.
In the Medicare Threshold Alerts System section, you can turn off the entire system or just specific alerts.
Save Settings at the bottom of the page. If you have multiple clinics, you will need to complete these steps for each additional clinic.

Medicare Allowable Fee Schedule within WebPT

Note: Fee Schedules in the WebPT EMR do not transfer to your billing software. To update your billing software's Fee Schedule, please do so from directly within the billing software.

Select your clinic name to open the drop-down menu and then select Medicare Fee Schedule.
From the Medicare Allowable Fee Schedule page, you can view, sync, and edit codes.
A key feature of the Fee Schedule is the Change Log. The Change Log is an audit trail of all changes a clinic administrator makes to the Medicare Allowable Fee Schedule. To view, select Change Log next to the Medicare Allowable Fee Schedule title.
To return to the Medicare Allowable Fee Schedule, select View Medicare Allowable Fee Schedule at the top of the page to the right of Medicare Allowable Fee Schedule Change Log.
Select Save to apply any changes in the bottom right.

Viewing A Patient's Medicare Threshold Progress (on the patient chart)

*Please note that WebPT will update the Medicare therapy threshold as changes are announced.

For patients with Medicare as the primary or secondary insurance on the case, the patient record will display two additional items

Medicare Threshold – OT Used/Remaining YTD
Medicare Threshold – PT/SLP Used/Remaining YTD

Until you complete your Medicare Allowable Fee Schedule, these items will remain at $0.00. Once completed the numbers will reflect the CPT codes entered since January 1st for the patient.

If your patient reaches the therapy threshold or goes above it, the year-to-date totals will turn red. The Amount Used column will return to $0.00 on January 1 of next year, and we will update it with the next year’s therapy threshold as published by Medicare.

Medicare Threshold Report

Visit here for information about the Medicare Threshold Report.