powered by LeadingAge New York

Part B Therapy Rate Tool Available

Members seeking a listing of 2020 Medicare Part B rates for therapy and other procedures commonly provided in nursing homes can access them in the Part B Therapy Rate Calculation Tool developed by LeadingAge National. Part B rates are adjusted regionally and are updated on a calendar year basis. The conversion factor (i.e., base amount) increased slightly from $36.0391 in 2019 to $36.0896 in 2020. The tool, which operates as an interactive Excel file, is available here. Login is required.

After downloading the tool, select the appropriate region to display the rates that apply for your county. There are five Part B regions in New York:

  • Manhattan (New York County)
  • New York City (NYC) Suburbs/Long Island (Bronx, Kings, Nassau, Richmond, Rockland, Suffolk, and Westchester counties)
  • Poughkeepsie/N NYC Suburbs (Columbia, Delaware, Dutchess, Greene, Orange, Putnam, Sullivan, and Ulster counties)
  • Queens (Queens County)
  • Rest of New York State (all other counties)

Please note that a full Fee Schedule lookup feature is usually available on the National Government Services (NGS) website here. NGS is the Medicare Administrative Contractor (MAC) for New York State. However, they have recently been experiencing technical difficulties that have made the lookup feature sporadically unavailable.

Medicare Part B covers some medical services provided to Medicare beneficiaries residing in nursing homes such as therapy and durable medical equipment. Most Part B services provided to nursing home residents who are not in a Part A-covered stay are not subject to consolidated billing requirements, and providers may submit separate claims to Medicare for each service. Medicare pays for these Part B services using a fee schedule. To prevent duplicate payments, the Medicaid reimbursement rate for residents who are also eligible for Medicare incorporates a uniform Part B offset. A fact sheet outlining the composition of Part B rates is available here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841