CY 2025 Physician Fee Schedule Proposed Rule

July 11, 2024-- Yesterday, July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the public inspection version of the Medicare and Medicaid Programs CY 2025 Physician Fee Schedule Proposed Rule. The proposed rule announces and solicits public comments on potential policy changes for Medicare payments under the Physician Fee Schedule (PFS), effective on January 1, 2025. The proposed rule will be published in the Federal Register on July 31, 2024. The PFS is the primary payment method for many providers including Physicians, Physical, Occupational, and Speech Therapists. Upon initial review there are several important proposed changes for providers:

‍

Supervision Policy for Physical and Occupational Therapists in Private Practice CMS is proposing a regulatory change to allow for general supervision of physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) by PTs and OTs in private practice (non-institutional). This proposal aligns with general supervision of PTAs and OTAs by PTs and OTs who work in institutional settings and is an important step in improving access to care. 

‍

Certification of Therapy Plans of Care with a Physician or Non Physician Practitioner (NPP) Order  For CY 2025, CMS is proposing amendments to the certification and recertification regulations. If finalized, these changes would provide an exception to the physician/NPP signature requirement on the therapist-established plan of care (POC) for purposes of the initial certification IF there is a written order or referral from the patient’s physician/NPP on file AND the therapist has documented evidence that the treatment plan was transmitted to the physician/NPP within 30 days of the initial evaluation. CMS does not propose to establish an exception to the signature requirement for recertification of the therapy POC after the initial certification period. 

‍

Reimbursement cuts Unfortunately, the proposal reflects cuts to payment rates. There are several factors affecting reimbursement.  The first is that the total relief of 2.93% that was provided by Congress this year only lasts through December 31, 2024, and CMS is bound to its current statutory limitations and therefore required to cut at least that amount from the 2025 budget. The second is the ongoing problem of budget neutrality requirements. Both factors resulted in a proposed overall reduction in reimbursement by 2.80%.  Actual reimbursement reductions will depend on multiple factors including specialty, codes billed and geographical area.  

‍

Telehealth Services Disappointingly, no extension of telehealth flexibilities was proposed. As it stands, beginning January 1, 2025, restrictions on telehealth that existed prior to the COVID-19 Public Health Emergency (PHE) will go back into effect. CMS did propose an Audio-Only inclusion, which states that interactive telecommunications systems may include two-way, real-time audio-only communication technology for any telehealth service furnished in a patient's home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but,permanently establish current telehealth flexibilities, the patient is not capable of, or does not consent to, the use of video technology.  CMS also proposed to add Caregiver Training Services (CTS) to the Medicare Telehealth Services List on a provisional basis.  

‍

KX Modifier Thresholds In the proposed rule, CMS outlines an MEI increase of 3.6% which results in proposed KX modifier threshold amounts of $2,410 for physical therapy (PT) and speech-language pathology (SLP) services (combined) and $2,410 for occupational therapy (OT) services. The threshold for targeted medical review (MR) for PT and OT (combined) and SLP remains at $3,000 through CY 2027 for CY 2025. 

‍

Powerback Rehabilitation will continue to advocate for a permanent fix to the PFS, legislation that will permanently establish current telehealth flexibilities and relief from the proposed PFS cuts.

Additional resources:

CY 2025 Physician Fee Schedule Proposed Rule

CY 2025 Physician Fee Schedule proposed rule fact sheet

‍