2025 Medicare Physician Fee Schedule Final Rule Includes Two Important Gains for Therapy Providers

APTA advocacy leads to effective policy gains that will reduce administrative burden, improve access, and provide greater flexibility to the therapy workforce.

ALEXANDRIA, Va., November 1, 2024 /PRNewswire/ — Reducing administrative burdens, ensuring patient access in rural and underserved areas, and providing flexibility for a demanding therapy workforce has long been a hot topic policy priorities On behalf of the American Physical Therapy Association. Now, with the latest version Centers for Medicare and Centers for Medicaid Services 2025 Medicare Physician Fee Schedule Final RuleSome of these priorities are being adopted to better support physical therapists and physical therapist assistants and their role in improving the health of Medicare beneficiaries.

The 2025 fee schedule includes two important policy achievements for the physical therapy profession advocated by APTA in the areas of PTA oversight and care plan certification.

Supervision of Physiotherapist Assistants: The supervision requirement for physical therapist assistants under Medicare Part B will change from the outdated direct supervision requirement to general supervision. This change will finally align outpatient settings with the general supervision policies implemented in all other Medicare settings. Moreover, 49 states currently allow general oversight of PTAs under state licensing laws; This means that Medicare’s requirement for direct supervision in the outpatient setting is more onerous than most state licensing requirements. This change will provide greater flexibility for the therapy workforce and ensure access to therapy services for millions of Medicare beneficiaries, especially in rural or underserved areas where beneficiaries are 50% more likely to receive treatment from a PTA. The language in the final rule reflects APTA-supported legislation introduced in the 118th Congress. EMPOWERMENT ActThis will require CMS to advocate for this change for a long time.

Therapeutic Plan of Care Certificate Requirement Reform: An exemption is made to the current burdensome plan regarding the current care signature requirement for outpatient services provided under the direction of a physician. Under current CMS policy, physical therapists are required to send care plans to the referring physician; this physician has 30 days to sign off on the services the referring physician originally ordered. If the 30-day deadline is approaching and the doctor still has not returned the signed care plan, it is the physical therapist’s responsibility to obtain this signature. Without this, PT faces issues such as failure to receive payment from Medicare or discontinuation of patient treatment, which can lead to interruptions in care. Under the new exemption, the care plan certification signature requirement will be deemed met if the physical therapist submits the care plan to the patient’s referring physician within 30 days of the initial evaluation; PTs no longer need to obtain the doctor’s signature. This change follows a defense of APTA during the CMS comment period and reflects APTA-supported legislation introduced in Congress. REDUCTION Act.

The Story Continues

“After years of advocacy, APTA is pleased that CMS has finally responded to our recommendations to improve patient access to essential therapist services and ease the administrative burden at a time when physical therapy practices are challenging, given year-over-year fee cuts,” said APTA President. Roger HerrPT, MPA. “The change in supervision requirements allows PTAs to practice at the top of their license, recognizing their critical role in patient care and support of therapy clinics. Reducing unnecessary administrative care plan requirements allows PTs to focus on patient care rather than paperwork. These two 2025 Medicare Physician Policy changes to the Fee Scheme are critical to supporting physical therapists and physical therapist assistants.”

2025 rule It also decided on a reduction in the conversion factor of the compensation plan. As in previous years, the budget-neutral policy led to a new cut in the conversion factor affecting all providers charged under the physician fee schedule, including physical therapists. Unless Congress intervenes (as it has done several times in past years), the 2025 conversion factor will be: $32.3562A decrease of 2.83% from 2024.

It is now up to Congress to stop implementation of the 2.83 percent cut. January 2025. In a bipartisan effort to address this problem, APTA-backed legislation Medicare Patient Access and Practice Stabilization ActIntroduced in the US House of Representatives on 29 October. If enacted, it would provide a 4.73% payment increase in the conversion factor of the 2025 Medicare Physician Fee Schedule.

“The continued reduction in payments for therapy services under the fee plan underscores the need to overhaul Medicare’s Physician Fee Schedule, and APTA will continue the fight to advocate for full-scale reform,” Herr added.

The American Physical Therapy Association represents more than 100,000 physical therapists, physical therapist assistants, and physical therapy students nationwide. Visit apta.org to learn more.

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SOURCE American Physical Therapy Association