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  • APTA Named 'Best in Business'

    APTA is not only making a national impact—it's making a difference in the local community and helping its employees stay healthy. And now the association has earned a significant recognition for those efforts.

    APTA was recently named "Best in Business" by the Alexandria, Virginia, Chamber of Commerce, an annual award that recognizes a local business that combines excellence in operations with a commitment to the Alexandria community. APTA originally was nominated for the award in the “large organization” category but took home the overall award among a field of 23 nominated businesses.

    APTA’s submission highlighted the level of engagement among APTA's members, its solid financial operations, and its efforts in the ongoing battle against the opioid epidemic—particularly it's #ChoosePT opioid awareness campaign. At the local level, APTA engaged with the community through its cosponsorship of the Chamber's annual disability awareness awards and women in leadership initiatives.

    Helping to strengthen APTA 's nomination were multiple initiatives stemming from its APTAServe program, a staff-driven effort that encourages local, national, and even international volunteerism by APTA employees. Those efforts have included blood drives, foodbank and school supply collections, and participation in the "Miracles Baseball League," a program that enables athletes with physical and intellectual disabilities to play baseball by pairing them with a volunteer. At a national level, APTA staff worked with volunteers to organize a Special Olympics FUNfitness screening and participated in "Shoes4Kids" drives. This year 2 APTA staff even traveled outside the US to engage in service by joining volunteers from MoveTogether to build, equip, and operationalize a new physical therapy clinic in San Pedro Sacatepequez, Guatemala.

    "This award is a recognition of what APTA can do when we combine an energized and engaged membership with careful financial stewardship and a staff that embraces the transformative values of the physical therapy profession," said APTA CEO Justin Moore, PT, DPT. "We have a lot to celebrate and be proud of as we finish out 2018 and move toward the new year and next century for APTA."

    The association's nomination also highlighted APTAFit, an employee health and wellness program that offers health-related services to staff, from healthy cooking workshops to individual consultations with health professionals to identify and achieve individual employee wellness goals.

    The Chamber of Commerce honor isn't the first major award APTA received in 2018. Earlier this year, the association earned separate national recognitions from the American Society for Association Executives—a Gold Circle award for its member renewal efforts, and a Power of A gold award for its collaborative and successful efforts to stop the cap on payment for therapy services under Medicare.

    CSM Delivers: Pain Science and the Challenge of Opioids

    Addressing the opioid crisis means not only steering health care's approach to pain treatment away from drugs but fostering a better understanding of pain itself. There's no time to lose.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, will deliver thought-provoking content on pain and opioids at a crucial time. Check out these suggestions, and find other relevant programming by searching the CSM programming page.

    Pain Talks: Conversations With Pain Science Leaders on the Future of the Field
    Join some of the most influential leaders in the field of pain science and rehabilitation for a discussion of the history of pain rehabilitation and how they personally became interested in the field, followed by an exchange on the current state of research on pain and its translation into clinical practice. The audience will be able to submit questions via text or email to the moderator for individual or panel discussion. Friday, January 25, 8:00 am–10:00 am.

    Opioid Issues in Athletes
    Opioid analgesics are the second most abused drug in the United States, with nearly half of students in seventh through twelfth grade having been prescribed these narcotics. These youth typically are athletes recovering from an injury or surgery—sometimes with devastating results. Find out about national efforts to address this issue, and hear the story of one athlete's journey from injury to addiction, and his long road back to health. Thursday, January 24, 8:00 am–10:00 am.

    Remapping Neuroplasticity and Pain in the Clinic: A Case Series Session
    There's growing evidence that graded motor imagery (GMI) can be used clinically to help desensitize a hypersensitive nervous system and provide hope for patients who are "too hot to handle." Body maps can be retrained within minutes through GMI, including normalizing laterality, motor imagery, mirror therapy, sensory discrimination, sensory integration, and more. Learn from published case studies and case series showcasing how brief GMI interventions can be readily applied in real-life clinics and result in immediate changes, thus accelerating recovery in people struggling with persistent pain. Saturday, January 26, 8:00 am–10:00 am.

    Interprofessional Pain Management for Older Adults With Cognitive Impairment
    Patients with cognitive impairment have difficulty or inability to communicate pain and discomfort because of cognitive, developmental, or physiologic issues, which is a major barrier to adequate pain assessment and achieving success in pain management interventions. This session is designed to help you respond to that challenge. You'll enhance your skills in recognizing pain in this population, identifying deficits and solutions through standardized tests and measures, and using interprofessional practice to improve outcomes. Saturday, January 26, 11:00 am–1:00 pm.

    Register for CSM by October 24 to grab early bird discounts and your chance to win a roundtrip ticket to the conference.

    CSM Delivers: Students and Early-Career PTs and PTAs

    You don't have to look very far to find an article that lists "physical therapy" as a hot, in-demand career. That's good news for students and newly minted physical therapists (PTs) and physical therapist assistants (PTAs), but it's also a challenge to the profession to ensure that those joining its ranks are prepared for and energized about their futures.

    The 2019 APTA Combined Sections Meeting, set for January 23-26 in downtown Washington, DC, will offer several sessions of particular interest to students, educators, and others interested in preparing the next generation of professionals. Here are a few suggestions.

    Future Momentum: Pushing Limits on Simulation to Maximize Student Preparation
    What's the state of simulation-based education in preparing PT and PTA students for the dynamic, fast-paced arena of acute and critical care physical therapy? How can faculty and clinicians leverage this technology to maximize its potential? Experience lively discussion from an expert panel of acute care physical therapist academic faculty as they debate and challenge our existing evidence base regarding simulation-based education to prepare the next generation of PTs and PTAs. Friday, January 25, 8:00 am–10:00 am.

    Competency-Based Education: Exploring Opportunities for Our Future
    How well do our professional curricula and educational methods prepare our learners to meet current and future needs of patients, communities, and society? Competency-based education (CBE) theories have existed for decades but have only recently been applied to medical education, including the use of competencies, milestones, and entrustable professional activities, with a de-emphasis on the time required to demonstrate competence. This session will center on evaluation of ongoing development of CBE in medicine and its potential application to physical therapy. Friday, January 25, 11:00 am – 1:00 pm.

    From Lightly Salted to Seasoned: Implementing Early Professional Development
    The shift from student to PT or PTA can be dramatic for some. What can be done to maintain and even increase engagement in the profession during this critical time? Join panelists involved with the Florida Physical Therapy Association's Early Professional Special-Interest Group (SIG) to discuss their efforts to maintain membership engagement and facilitate the transition from new graduates to early-career professionals and further into association leadership. Thursday, January 24, 3:00 pm–5:00 pm.

    Register for CSM by October 24 to grab early bird discounts and your chance to win a roundtrip ticket to the conference.

    The Good Stuff: Members and the Profession in the Media, October 2018

    "The Good Stuff," is an occasional series that highlights recent media coverage of physical therapy and APTA members, with an emphasis on good news and stories of how individual PTs and PTAs are transforming health care and society every day. Enjoy!

    PT student makes Team USA: Faith Farley, SPT, earned a position on Team USA to compete in the 2018 functional fitness world championship. (HuntingtonNews.Net)

    The right bike fit: Larry Meyer, PT, DPT, offers a motion-analysis system that incorporates a cyclist's technique into an evaluation designed to provide the best possible cycle-rider fit. (velonews)

    Global PT Day of Service, student-style: Wheeling Jesuit University (West Virginia) physical therapy students spent their Global PT Day of Service cleaning up and resurfacing a local playground. (Wheeling, West Virginia, Intelligencer News Register)

    Success in the long run: Staci Whitman, PT, just completed running the 6 biggest marathons in the world, known as the World Marathon Majors. (Arizona Daily Sun)

    Taking youth sports concussions seriously: Kelly Isakson, PT, explains the screenings and other services she offers youth athletes, and why they're important. (Moscow-Pullman, Idaho, Daily News)

    When QWERTY's not your type: Kevin Weaver, PT, DPT, weighs in on possible replacements for the standard computer keyboard. (MIT Technology Review)

    Is that surgery kneeded? Daniel Riddle, PT, PhD, FAPTA, discusses his research on inappropriate knee surgery. (New York Times)

    Never too old for fitness: Alice Bell, PT, DPT; Paul Gardner, PT; and Greg Hartley, PT, DPT, offer insights on fitness after age 50. (Reader's Digest)

    The student Ironman: Megan Gibbons, SPT, has qualified for the World Ironman Championship. (WBRE/WYOU News, Scranton, Pennsylvania)

    Up to your neck in headaches: Jennifer Penrose, PT, DPT, explains the origins of cervicogenic headaches. (thurstontalk.com)

    Cream of the crop: Brenau University (Georgia) students Jean-Marie Peters, SPT; Amber Holmes, SPT; and fellow BU PT students joined faculty members Robert Cantu, PT, EdD; and Tammy Buck, PT, DPT, in a unique program that brings students to migrant farming communities to provide care—and get a taste of the physical demands of migrant labor. (Brenau University Window online)

    Quotable: "These dedicated people have been there on our Grace-Filled Journey every step of the way. They've cried with us during hard times and they've helped us celebrate the smallest milestones that most people wouldn't even think twice about. But most importantly to us, they never give up on Grace. Some days, Grace's biggest accomplishment is a smile, but that doesn't stop any of her therapists from working hard and encouraging her (and us) to celebrate all that life has to offer." – Mary Herschelman, on the physical therapists, speech-language pathologusts, and occupational therapists who have worked with her daughter Grace, who has infantile neuroaxonal dystrophy. (Hillsboro, Illinois, Daily News)

    Got some good stuff? Let us know. Send a link to troyelliott@apta.org.

    Study: Many Gaps Still Exist in Insurer Coverage of Nondrug Treatments for LBP

    According to authors of a new study, physical therapy and occupational therapy to treat low back pain (LBP) frequently may be included in public and private insurer plans, but there's a lack of consistency in factors such as copays, referral requirements, prior authorization, and treatment limits. Coupled with a general lack of attention to many other nonpharmacological approaches to LBP, the inconsistencies create coverage gaps at a time when increased emphasis is being placed on nonopioid pain treatment, they write.

    The study, published in JAMA Network Open, looked at 2017 data from 15 commercial, 15 Medicaid, and 15 Medicare Advantage (MA) health plans in 16 states selected to provide a cross section of relative wealth, geographic location, and other factors. In addition to the insurers studied—a sample that authors claim represents insurers of more than half of the nation's populace—researchers also interviewed 43 "senior medical and pharmacy health plan executives" to get their take on the use of, and barriers to, nonpharmacological treatments for LBP.

    Researchers were interested in the degree to which insurers were covering nonpharmacological treatments for LBP and, if so, what restrictions they were placing on that use. It's an area in need of study, they say, given the current opioid crisis, the link between later opioid abuse and initial prescriptions of opioids to treat pain, and recommendations from the US Centers for Disease Control and Prevention (CDC) and others pushing for nonopioid approaches as first-line treatment for chronic noncancer pain.

    The study focused on 5 nonpharmacological therapies for LBP across all plans: physical therapy, occupational therapy, chiropractic care, acupuncture, and therapeutic massage. Additionally, because the information was readily available through Medicaid, researchers added 6 more approaches to their review of Medicaid plans: transcutaneous electrical nerve stimulation (TENS), psychological interventions, steroid injections, facet injections, laminectomy, and discectomy. Here's what they found:

    Physical therapy and occupational therapy fared well in terms of medical necessity.
    Among both commercial insurers and MA, physical therapy and occupational therapy were almost always deemed a "medical necessity" and thus subject to coverage. Of the commercial insurer coverage policies reviewed, all included physical therapy, and all but 1 included occupational therapy.

    But exactly how that physical therapy is covered? That's another matter.
    Researchers found that when it comes to utilization management issues, not all plans are equal. Among the 15 commercial insurers studied, researchers found 1 instance of prior authorization requirements, 10 instances of limits put on visits to a physical therapist (PT), and 1 instance of a referral requirement. The prior authorization (PA) situation in MA is worse (a fact that APTA is working with other groups to change), with 5 of the 15 plans studied requiring PA, and 1 requiring a referral.

    Copays can vary, too—sometimes by a lot.
    In the MA plans studied, patient copays for physical therapy for LBP ranged from $32.50 to $40 per session; the range was $15 to $50 per session among the commercial payers.

    Coverage for other nonpharmacological treatments for LBP is spotty.
    Of the commercial plans studied, only a few conferred "medical necessity" status on acupuncture (3 providers), TENS (3 providers), steroid injections (3 providers), and facet injections (3 providers). The MA system consdiered TENS, steroid injections, and facet injections medically necessary.

    Medicaid reflected the same general coverage patterns.
    As in the commercial and MA study group, the Medicaid plans included in the research largely covered physical therapy and occupational therapy (14 of 15, with the remaining plan being "unclear or not found"). All other treatments were in the single digits, with the exception of TENS (10 plans covered) and chiropractic care (12 plans covered).

    Are health plan execs on board with making it easier to access nonpharmacological pain treatments? Not exactly.
    In their interviews with health plan executives, authors of the study found that "overall, informants indicated a low level of integration between coverage decision making for nonpharmacologic and pharmacologic therapies." Researchers noted that when the interviewees did mention "innovative strategies to combat the opioid epidemic," those strategies tended to center around improved formulary management of opioids, substance abuse treatment, and identification of opioid over-users and over-prescribers—"less so on innovations aimed at optimizing coverage and access to nonpharmacologic therapies for chronic pain," they write.

    "The findings of this study support what we find on the ground with our members—namely, that while we have made progress in areas such as basic coverage and direct access, there's still much more work to be done to increase patient access to physical therapy and other nonopioid treatments," said Carmen Elliott, MS, APTA vice president of payment and practice management. "That's why we continue to engage with commercial payers, utilization management providers, and insurer interest groups to help them find a way to apply the evidence of physical therapy's effectiveness to their own policies."

    Authors of the study echo that sentiment, writing that "despite a growing evidence base supporting the effectiveness and cost-effectiveness of many of the nonpharmacological treatments examined in our study, our findings depict inconsistent and often absent coverage for many of these treatments."

    These inconsistencies present a challenge for patients, particularly those who are pursuing a multidisciplinary approach to treatment, they add.

    "Treatment-based approaches can require a co-payment for each visit, in addition to costs associated with travel and missed work," authors write. "These issues are multiplied if a patient is taking a multipronged approach that incorporates multiple therapies for chronic pain. In addition, the wide variation in utilization management criteria…underscores the uncertainty that may exist around what constitutes an appropriate duration and intensity of treatment (eg, physical therapy) for chronic noncancer pain."

    Authors of the study believe the way out of this dilemma may depend on establishing and promoting the evidence base for nonpharmacological pain treatment and—most important—for these treatments to be widely used by providers.

    "Utilization management requirements were highly variable, which speaks to a need for evidence-based guidance regarding optimal use of these therapies, and standardized, comprehensive training for practitioners to effectively implement the evidence base into their practice," they write.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

    US House Members Echo APTA, Coalition Members' Call for Reduced Use of Prior Authorization by Medicare Advantage Plans

    Calling the requirements "onerous and often unnecessary," more than 100 members of the US House of Representatives are pressing for improvements to the way prior authorization (PA) is used—and often misused—in Medicare Advantage (MA) plans. The lawmakers' call for changes echoes concerns voiced earlier this year by a coalition that includes APTA.

    A bipartisan group of 103 legislators signed on to the October 10 letter to US Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma, requesting that Verma direct the agency to conduct investigations around the use of prior authorization in MA, and to issue guidance "dissuading" MA plans from including requirements that include unnecessary barriers to care.

    "It is our understanding that some plans require repetitive prior approvals for patients that are not based on evidence and may delay medically necessary care," the lawmakers write. "Many of these PA requirements are for services or procedures performed in accordance with an already-approved plan of care, as part of appropriate, ongoing therapy for chronic conditions, or for services with low PA denial rates."

    The letter underscores the message delivered to Verma earlier this year by way of a letter from the Coalition to Preserve Rehabilitation (CPR), a group of 28 health provider, patient, and care professional and advocacy groups that includes APTA, the American Association of People with Disabilities, the American Occupational Therapy Association, the Brain Injury Association of America, the Epilepsy Foundation, the Michael J. Fox Foundation for Parkinson's Research, and the Paralyzed Veterans of America, among others.

    The CPR letter suggests that CMS take its cue from the private insurance industry, which has been moving away from prior authorization, or at least investigate which prior authorization policies get in the way of medically necessary care. The coalition also recommends that CMS impose greater oversight of MA plans, with "stronger directives to MA plans to limit the use of prior authorization to services that are demonstrably overutilized."

    The legislators' letter to Verma makes reference to the efforts of "key stakeholders"—presumably, CPR and other groups—and requests that "you and your staff engage with these organizations on additional opportunities to improve the PA process for all stakeholders."

    APTA will continue to monitor this issue and share developments as they arise.

    Updated MedPAC 'Payment Basics' Series Provides Medicare Payment System Overview

    Given some of the major shifts in the Medicare payment landscape over the past few years, gaining an understanding of even the big-picture workings of the system can be a tall order. The Medicare Payment Advisory Commission (MedPAC) offers an updated resource that can help.

    Now available for free download: MedPAC's latest version of "Payment Basics," a series of informational sheets that describe the need-to-know elements of 20 different Medicare payment systems. Areas covered include outpatient therapy, skilled nursing facilities, home health services, hospital acute inpatient services, and more. The newest version of the resource updates the 2015 edition.

    Most information sheets provide background on how the system is organized and flowcharts for a visual representation of how that particular payment system works.

    Quick facts from MedPAC Payment Basics: According to the MedPAC report on outpatient therapy, in 2016 Medicare spent $7.6 billion on outpatient therapy services, a 6% increase from 2015. Physical therapy services accounted for 72% of all spending in this area. In terms of settings, nursing facilities and physical therapy private practice clinics accounted for 71% of the spending, at 37% and 33%, respectively. Hospitals were next, at 16%.

    New Report Looks at Link Between Surgery-Related Opioid Prescriptions, Later Opioid Abuse

    Calling surgery "a long-ignored gateway to persistent opioid use, dependence, and addiction," the Plan Against Pain (PAP) has issued a new report that focuses on the relationship between opioid prescriptions for surgical procedures and later opioid dependence and abuse. The bottom line: though there are glimmers of hope, the overall outlook remains bleak, with 12% of patients who had a soft tissue or orthopedic operation in the past year reporting that they had become addicted or dependent on opioids after surgery. APTA's #ChoosePT opioid awareness campaign is a Selected Partner of PAP.

    The report, which tracks surgery-related prescribing rates overall and as linked to 7 common surgical procedures—including total knee arthroplasty (TKA), total hip arthroplasty (THA), and rotator cuff repair—also breaks down statistics by demographic and geographic variables. Researchers relied on data from the National Prescription Audit, the PharMetrics Plus Database, and surveys of 500 US adults who had soft tissue or orthopedic surgery in the past 12 months. In addition, 200 surgeons were surveyed to assess, among other issues, their motivations for prescribing opioids. The study results were released on October 10 in conjunction with the "Summit for Solutions" event In Washington, D.C., attended by APTA.

    Among the findings:

    Overall opioid prescription numbers are declining, but state rates vary dramatically.
    Nationally, in 2017, there were enough opioids prescribed to supply every person in the US with 32 pills, only a slight decrease from the 36-pill rate reported in 2016. And while every state in the country reported a drop in opioid use in 2017, those reductions varied widely, and the improvements for some states, while significant, only made a dire situation slightly better. Example: Alabama, the nation's top opioid-prescribing state, recorded a 10% decrease in opioid prescriptions between 2016 and 2017, but that only brought its opioid pills-per-resident ratio down to 65 pills for every resident—more than twice the national average.

    Progress has been slow in reducing opioid prescription rates related to surgery.
    Researchers found that among the 7 surgeries studied—TKA, THA, rotator cuff surgery, hysterectomy, hernia surgery, colectomy, and sleeve gastrectomy—the average number of opioid pills prescribed dropped, but only slightly, from 85 pills per patient to 82. Authors of the report speculate that the slow progress could be due in part to the level of pressure surgeons feel to prescribe more opioids then they feel are necessary—a pressure reported by 66% of surgeons surveyed.

    The number of pills prescribed doesn't tell the whole story. The use of fewer pills at a higher potency also poses a risk—especially for orthopedic patients.
    The study found that more than half of patients undergoing TKA, THA, and rotator cuff surgery were prescribed opioids of 50 or more morphine milligram equivalents (MMEs), more than double the 20 MME dosage recommended by the US Centers for Disease Control and Prevention (CDC). Nearly 1 in 4 orthopedic patients received prescriptions in excess of 90 MMEs per day, an amount that the CDC says poses a serious overdose risk.

    Average rate of later opioid dependence and addiction among surgical patients hovered at 12%, but was higher for TKA patients.
    Patients who received colectomy reported the highest incidence of later dependence, at 17%, but TKA patients weren't far behind, with a 15.2% rate of later misuse. Rotator cuff surgery and THA patients reported lower rates of later dependence, at 9.5% and 9.3% respectively. The 12% overall average is an increase from the 2017 study, which estimated the later dependence rate at 9%.

    Women—and Millennial women in particular—are the most at-risk for becoming "newly persistent" opioid users after surgery.
    Women were found to be 40% more likely than men to become "newly persistent" users—individuals who received opioid prescriptions 90 to 180 days post-discharge. Millennial women were found to be particularly at-risk, with more than 10% reporting persistent use, compared with 6% or Millennial men. The persistent use rate for Millennial women in the 2018 PAP study represents a 17% jump from the previous survey.

    Authors of the report believe that until better guidelines are developed it's unlikely gains can be made in more careful use of opioids related to postsurgical pain. Although there has been some progress in this area, they write, more needs to be done to "relieve the pressure surgeons often feel to prescribe more opioids than patients actually need and help set patient expectations on the amount of opioids they'll be prescribed."

    "[The lack of clear guidelines] has left surgeons mainly on their own in determining the appropriate quantity and strength of opioids needed to address their patients' pain," authors write. "As this report reveals, the absence of clear guidelines has led to tremendous variation in prescribing patterns and a great deal of overprescribing that can lead to persistent opioid use, addiction and dependence among patients, as well as unused pills that can be misused or abused by others."

    APTA has been heavily engaged in the fight against opioid misuse on several fronts. In addition to its flagship #ChoosePT opioid awareness campaign, the association also hosted a Facebook Live panel discussion and satellite media tour to highlight the effectiveness of nonopioid approaches to pain management. In addition, APTA produced a white paper on reducing opioid use and contributed to the National Quality Partners Playbook on Opioid Stewardship.

    It's World Arthritis Day: 5 Great Resources

    World Arthritis Day, October 12, calls attention to a global problem in need of better public awareness: how exercise and education can reduce the impact of the disease. And there's little time to waste: according to a 2016 study, by 2040, an estimated 25% of Americans will have arthritis, and 1 in 10 will experience a disability related to the condition.

    In honor of the day, here are 5 great resources that can help you develop community-based arthritis programs.

    Understand the basics of evidence-based community arthritis programs.
    What physical activity programs should you be looking for? Why recommend one program over another? What do the programs have in common? This quick reference guide from APTA helps you learn the lay of the land.

    Find the best fit for you and your patients.
    A program's target population, program length, class size, availability, and instructor requirements, can all be important factors in deciding which program would work best for you. APTA's decision aid can help narrow down the options.

    Bring patients and other community members on-board with resources from MoveForwardPT.com.
    APTA's consumer-focused website helps to explain the importance of arthritis programs, and provides an overview of some of the most highly regarded offerings from the US Centers for Disease Control and Prevention), the Arthritis Foundation, the Aquatic Exercise Association (, and others.

    Get help from the experts.
    APTA is a founding member of the US Bone and Joint Initiative (USBJI), a multidisciplinary education and advocacy group that provides extensive resources on arthritis and other musculoskeletal conditions. The USBJI's "Experts in Arthritis" webpage is loaded with videos and other public education resources that can help you help your patients and others understand the disease and the role that exercise can play in countering its effects.

    Dive into a website that's all-things-arthritis.
    As a member of the Osteoarthritis Action Alliance (OAAA), APTA helped to create some of the content and educational offerings available on this expansive site built for both consumers and clinicians. Resources include monthly "lunch and learn" webinars, information for providers, and research roundups.

    [Editor's note: even more information on arthritis is available at PTNow, including tests and clinical guidelines.]

    APTA Advocacy for EMG, Other Diagnostic Services Results in Payment Clarification from CMS

    Good news for physical therapists (PTs) certified by the American Board of Physical Therapy Specialties in electrophysiologic physical therapy: the US Centers for Medicare and Medicaid Services (CMS) has stated in no uncertain terms that those PTs are permitted to perform certain diagnostic services without the need for physician supervision where those services are allowed by state law. The announcement was made after APTA and other stakeholders pressed the agency to clear the air in order to end payment reductions or outright denials to PTs providing the services.

    According to the CMS statement, board-certified clinical specialists in electrophysiology physical therapy are qualified to provide services involving electromyography (EMG), nerve conduction velocity (NCV), and sensory evoked potentials (SEPs) without physician supervision, and should be paid for those services. It's a provision that's been around since 2001, according to CMS; however, the message wasn't always getting through to some Medicare Administrative Contractors and other payers, who would pay only for the technical component of the service, for some codes but not others, or nothing at all.

    In its statement, CMS reminds stakeholders that it assigns a Physician Supervision Indicator (PSI) of “09” to its collection of PT-designated diagnostic services codes, making it clear that physician supervision is not required for the global and professional component codes of these services.

    "APTA was concerned when it became clear to us that PTs weren't receiving appropriate recognition for these services, but grateful that the issue could be resolved through clear communications from CMS," said Kara Gainer, APTA director of regulatory affairs. "We hope that this statement will erase all doubts about whether a qualified PT can receive full payment for the delivery of services that have been permitted for nearly 2 decades."