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2025 Proposed Medicare Physician Fee Schedule

11 Jul 2024 10:51 AM | Zachary Edgar (Administrator)

Payment Rate Cut

Average payment rates under the PFS are proposed to be reduced by 2.93% in 2025 compared to the average amount these services are being paid for most of 2024. The change to the PFS conversion factor incorporates the 0.00 percent overall update required by statute, the expiration of the 2.93% increase in payment for 2024 required by statute, and a relatively small estimated 0.05% adjustment necessary to account for changes in work relative value units (RVUs) for some services. This amounts to a proposed estimated 2025 PFS conversion factor of $32.36, a decrease of $0.93 (or 2.80%) from the current 2024 conversion factor of $33.29.

Supervision Policy for Physical Therapists (PTs) and Occupational Therapists (OTs) 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 in private practice (PTPPs) and OTs in private practice (OTPPs) for all applicable physical and occupational therapy services.

General supervision means that supervising PTs and OTs can be off-site while PTAs and OTAs treat patients, therapists must be available by phone.

This proposed change will give PTPPs and OTPPs more flexibility in meeting the needs of beneficiaries and safeguard patient access to medically necessary therapy services, including those experiencing challenges accessing these services in rural and underserved areas; and it will align with general supervision of PTAs and OTAs by PTs and OTs who work in institutional providers.   

 

Certification of Therapy Plans of Treatment with a Physician or NPP Order

CMS is proposing amendments to the certification and recertification regulations to lessen the administrative burden for therapists and physician/NPPs. These changes, if finalized, would provide an exception to the physician/NPP signature requirement on the therapist-established treatment plan for purposes of the initial certification in cases where a written order or referral from the patient’s physician/NPP is 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 is also soliciting comments, as suggested by interested parties, as to the need for a regulation addressing the amount of time during which the physician/NPP who has written an order for therapy services could make changes to the therapist-established treatment plan by contacting the therapist directly, and whether there should be a 90-day (or other) limit to the physician/NPP order extending from the order date to the first date of treatment/evaluation by the therapist.


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